In this episode of The Better Care Podcast, EvidenceCare's VP of Clinical Strategy, Carol Howard, hosts a live panel of experts on regulatory updates and strategies for health systems related to Medicare Advantage and the two midnight rule to assure compliance and optimize revenue capture.

Guests:

• Jackie Kimmell, Senior Director of Strategy Catalyst, The Health Management Academy
• Dr. Adam Fall, Corporate Medical Director of Utilization Management, Erlanger Health System
• Dr. Jeny McNair, President and Chief Physician Advisor, Physician Advisory, Med-Metrix

Key Takeaways:

• Medicare Advantage (MA) plans are set to grow significantly, prompting policy changes to control federal spending, such as the Version 28 HCC Model and adjustments to star ratings.
• Hospitals are encountering increased payer friction, with a significant rise in MA denials and a need for robust strategies to manage Medicare patient classifications.
• Proper documentation and understanding of payer rules, including the CMS two midnight rule, are paramount to minimizing administrative burdens and ensuring appropriate reimbursements.
• The importance of contract negotiations, advocating for shorter contract terms and clear terms regarding the use of AI in care management.
• The potential impact of the Chevron ruling on medical necessity appeals could lead to significant legal and operational shifts in how hospitals manage and appeal payer decisions.

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The Better Care Podcast is produced by EvidenceCare.

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