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Ten providers recently posted job listings seeking leaders in payer contracting and relations. Note: This is not an exhaustive list.…
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As 2027 approaches, Medicare Advantage plans are navigating tighter margins, increased oversight and higher expectations for accuracy. They are entering a more constrained environment where performance, not volume, will determine financial outcomes. From expanded RADV audit exposure to tighter expectations…
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CMS published its final 2027 Medicare Advantage and Part D rule on April 2, enacting changes to star ratings, supplemental benefits administration, Part D coverage, and a series of deregulatory provisions. The rule is effective June 1 and applies to…
Aetna appointed Lisa Baird as the CEO of Aetna Better Health of Missouri and Corey Pleasants as CEO of Aetna Better Health of Pennsylvania, according to April 2 LinkedIn posts. Ms. Baird has spent nearly 20 years leading Aetna Medicaid…
Oregon Health Plan Bridge, the state’s basic health program, did not comply with income requirements, according to a March 31 audit from the Oregon Secretary of State. Auditors issued an adverse opinion of the program, which was implemented in July…
Carolina Complete Health and WellCare of North Carolina, both Centene Corp. subsidiaries, secured regulatory approval to move forward with their merger to form a managed care organization, according to an April 2 news release from the parent company. The entity…
Women keep your hospital moving. An MSK plan designed around women’s health can keep them physically, mentally and emotionally engaged while keeping your hospital healthy. Download this e-book to uncover insights about the women at your health system. You’ll learn…
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Healthcare has spent the last decade digitizing clinical and financial workflows. Transportation is one of the last major functions still operating without true infrastructure—and it is costing health plans more than they realize. Non-emergency medical transportation (NEMT) exists to solve…
Clinical Documentation Integrity (CDI) teams play a critical role in ensuring diagnoses are accurate, supported, and reflective of the care delivered. But as charts grow more complex and payer scrutiny of retrospective documentation review increases, changes to documentation that happen…
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Dr. David Kirk, MD
Chief Medical Officer, Regard
Fran Jurcak MSN, RN, CCDS, CCDS-O
Independent Consultant – CDI and Revenue Cycle
Pharmacy procurement becomes increasingly difficult to manage as health systems expand. Many organizations have centralized strategies in place, yet purchasing decisions remain reactive. The result: inconsistency, missed savings and increased compliance risk across the enterprise. This session explores where traditional…
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Presenters
Jessica Daley
Consultant, Pharma Logistics
Calvin Hunsicker
Founder and Chief Product Officer, SureCost
Chad O’Connor
VP/GM Acute, SureCost
CMS awarded its Medicare Advantage independent review entity contract to C2C Innovative Solutions, according to a March 31 CMS letter published by the AMA. C2C secured the contract Feb. 26. Effective May 1, C2C will review appeals of adverse reconsiderations,…
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