Steve Solomon

A new state law mandated a specific, detailed process for #Medicare and #Medicaid payers. One coordinated care organization didn’t have the knowledge or resources to ensure #compliance. They needed an active partner. EXL brought domain expertise, a flexible approach, and a skillful team who designed a solution that prevented the organization from losing any recoveries. Find out how in our case study.

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ON-DEMAND WEBINAR: Is your RCM partner up to today’s security challenges? If you’re unsure, it’s time to find out. Watch to uncover how recent cybersecurity events have refocused vendor-selection requirements and what to evaluate during review.  #Cybersecurity #RevenueCycleSecurity #RCMSecurity

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CVS Health, Humana, and Centene are among the payers with the highest medical cost ratios in the first quarter of 2024. According to the latest report by Becker's Payer, payers with larger Medicare populations are struggling the most. Here's how the payers compared in Q1 2024: CVS Health  Q1 2024: 90.4%  Q1 2023: 84.6% Humana Q1 2024: 88.9%  Q1 2023: 85.9%    Centene  Q1 2024: 87.1%  Q1 2023: 87%    Elevance Health Q1 2024: 85.6%  Q1 2023: 85.8%    UnitedHealth Group Q1 2024: 84.3%  Q1 2023: 82.2%    Cigna Group  Q1 2024: 79.9% Q1 2023: 81.3% Compared to the previous year, CVS Health and Humana saw an increase in their medical cost ratios, while UnitedHealth Group had a slight increase. On the other hand, Cigna Group saw a decrease in their medical cost ratio. To learn more about the rankings, check out the source: https://lnkd.in/e9cQU9Hu

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Anil Bhatt, global CIO of US health insurance provider Elevance Health, began his career navigating early challenges and skepticism, which included convincing the security near the Prime Minister's residence in Delhi about his work installing a pioneering point-of-sale system. From these beginnings, he is now leading technological advancements at Elevance Health, such as leveraging AI for operational efficiency and improving customer healthcare access. Bhatt emphasises the importance of data-driven decision-making, customer-focused technology solutions and fostering a culture of inclusivity and questioning within the workplace. Read the article by Vinita Bhatia to know how Bhatt is driving digital transformation in healthcare. https://lnkd.in/gU5eGq_s #healthcare #digitalisation #AI #inclusivity #technology

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If adjudicating claims is a tough task for payers, it is even harder for providers. Thirdwave automates adjudication for you, returning unrivaled rebate revenue...and more. Contact us to learn more. https://lnkd.in/gdC-uQBR #ThirdwaveRx #hospitals #pharmacies #longtermcare

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Insurance Discovery finds active primary, secondary, and tertiary patient coverage – as well as their Medicare Beneficiary Identifier (MBI) and demographic details – all in one quick inquiry. Get enhanced clarity on patient coverage, increased efficiency and accuracy in patient access, and improved back-end revenue cycle management (RCM) results, made possible by front-end success. Explore Insurance Discovery: https://ow.ly/OS9Y50RlHv7 #HealthcareSoftware #PatientAccess #InsuranceDiscovery #FrontEndRCM

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🚨 Medicare Star Rating Changes🚨 Big changes are coming to Medicare Advantage Star Ratings, and they could impact your future plans! The CMS is recalculating star ratings, and the implications are HUGE. 📊✨ Wondering what this means for you? We’ve got you covered. From adjustments in measure weights to the introduction of new measures, this comprehensive guide breaks down everything you need to know. 🔍 Click below to read the full article and get all the insider details. #Healthcare #MedicareAdvantage #StarRatings #CMS #HealthcareInnovation #StayInformed #ProTips

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Discover the intricacies of the insurance claim reimbursement process in the USA with this informative video. It's not just for hashtag #medicalbillers in India; anyone curious about the hashtag #Americanhealthcare insurance reimbursement model can benefit. Ever wonder why doctors in the USA lose substantial amounts of money each year? You'll be able to find out here if you understand Hindi. Feel free to share with your employees if you are a hashtag #healthcarebpo इस एक वीडियो से आप पूरा अमेरिकन सिस्टम समझ जाएँगे। अमेरिकन स्वास्थ्य सेवाये कैसे डॉक्टरों को पैसा भेजती है। क्यों अम���रिका के डॉक्टर २०%-३०% पैसा हर साल खो देते है This will answer the following questions. Why insurance claim is denied? Why is insurance paying $0 for your Claims? What is the process of handling medical claims denial? How to save medical claims denials? Why do medical insurance reject claims? Why do we need to call insurance companies to resolve claims? Why is payment posting the source of understanding AR calling? Why is the front desk failing to resolve medical claims? अगर पैसा नहीं आये तो मरीज़ क्या करते है। अगर पैसा नहीं आये तो मेडिकल बिलर क्या करे? https://lnkd.in/e3q3w8Re

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In September 2022, the Centers for Medicare & Medicaid Services (CMS) competitively awarded us a nine-year contract for Contact Center Operations (CCO), which helps more than 75 million Americans access Medicare and health insurance under the Affordable Care Act. For more than six years, our team has been the passionate voice on the other end of the line, helping Americans navigate their healthcare options every day. However, despite historically high customer service ratings and uninterrupted performance, HHS is recompeting the contract 7 years early to insert an unnecessary union organizing agreement, which is a flawed fix to a non-existent problem. The recompete requires the contractor to negotiate and execute an organizing agreement with any and all labor unions who informally claim to represent the employees, even if employees are not interested in joining by forcing employees into a labor organization. This inappropriate decision to recompete these services violates long-standing policy that the United States government remains impartial between federal contractors and labor organizations. Maximus is challenging the premature, improper, and unlawful re-procurement of our highly successful operation. Check out this piece by The Washington Post: http://spr.ly/604294a06 It does a great job explaining the motivations behind HHS’ decision to rebid the CCO contract and provides helpful insight into what this means for our employees, the communities where they live and work, small businesses, and millions of Americans who rely on this program.

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#MedicareAdvantage is seeing growing enrollment in Arkansas, but how is it different from traditional #Medicare, and why have some healthcare providers raised concerns about it? We take a look in our latest explainer.

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Navigating the new CMS regulations can be a complex journey, but it's also an opportunity to innovate and strengthen our approach to Medicare member acquisition and retention strategies.   As we adapt to these changes, and many payers are re-evaluating their sales distributions channels, leveraging technology to enhance compliance and efficiency in our sales processes will be key in speed to proficiency. It's not just about adjusting the call flow; it's about creating a seamless experience that prioritizes the needs of Medicare beneficiaries.   By asking the right questions and being proactive in our strategies, we can turn these regulatory shifts into a catalyst for positive transformation in how we serve our members. How can we strategically mobilize our recruitment and onboarding processes to accommodate the volume traditionally managed by brokers? What innovative technological solutions can we implement to empower our sales team to perform at their peak within a compliant framework? Are our member acquisition strategies designed with a foresight that prioritizes long-term retention and member satisfaction? See link in comments to our strategy guide for success.

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Transforming Healthcare: The National Health Claim Exchange (NHCX) The Health Ministry and IRDAI are set to revolutionize healthcare with the NHCX, a digital platform aimed at enhancing access to quality healthcare while reducing out-of-pocket expenses. Here's a glimpse of what to expect: Key Points: -The NHCX will facilitate seamless exchange of health claims data, streamlining interactions between hospitals and insurers. -Cashless claims will be processed within three hours, ensuring swift and efficient claim settlement for patients. -The NHCX platform already has over 30 insurance companies onboard, with efforts underway to bring in hospitals. -Financial incentives under the Digital Health Incentive Scheme will encourage digital health transactions and digitization of patient health records. Addressing Challenges: -The NHCX seeks to standardize and streamline health claims, reducing operational costs and fostering predictability and transparency in healthcare pricing. -Challenges such as discharge delays and miscommunication between hospitals and insurers will be addressed through the NHCX portal, leading to more efficient services and smoother operations within the healthcare space. -The NHCX is set to revolutionize the healthcare ecosystem, bringing efficiency, transparency, and enhanced patient care to the forefront. Source- https://lnkd.in/d--AKwst #NHCX #HealthcareRevolution #DigitalHealthcare #InsuranceInnovation #InsuranceBrokers #InsuranceAdvisors #HealthPolicy

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