Reimbursement
<p>Payers have seen success in improving health outcomes by taking a holistic approach to member interventions, says Leah Dewey, vice president of Cotiviti.</p>
Healthcare leaders will confront sustained upward pressure on compensation for these roles moving forward, report finds.
The associations' primary recommendation is to retire CMS' Severe Sepsis/Septic Shock Management Bundle.
Pushing the needle on value-based care will require buy-in from employers, says Susan Dentzer, president and CEO of APG.
These hospitals had an average operating margin of -8.6%, compared with -1.4% for all other hospitals, based on Medicare cost report data.
This year, 31 plans earned 5 stars, compared to 57 in 2023 and 74 in 2022.
Optum growth led the way, with the subsidiary's revenues growing 22% year-over-year to $56.7 billion.
Most of the selected diagnosis codes that Aetna submitted to CMS didn't comply with federal requirements, OIG says.
The modifications are in line with the industry as a result of the PHE ending in May, Aetna says.
The lawsuit was linked to past risk adjustment submissions from certain types of patient records, some dating back more than a decade.