Even before the pandemic, telehealth was gaining real traction as more and more payers began to recognize the benefits across the healthcare continuum – for patients, providers and payers. Its value proposition in terms of facilitating quicker response to patient needs, more collaboration between healthcare professionals, and perhaps most significantly, in reducing unnecessary Emergency Department…

On December 2nd, 2020, the Centers for Medicare & Medicaid Services (CMS) released its 2021 Outpatient Prospective Payment System (OPPS)/Ambulatory Surgical Center (ASC) Final Rule. Among the significant changes are: The elimination of the inpatient only list over three calendar years beginning with the removal of an estimated 300 musculoskeletal-related charges. The list will be…

The Healthcare Financial Management Association (HFMA) recently wrote about utilization reviews (UR) and how many acute care hospitals are losing revenue due to common “breakdowns” in the UR processes. Cited were five key areas where problems often lie. They included: department organization and management, failure to understand or properly adopt regulatory guidelines, challenges relating to…

ZeOmega Helps Leading Medical Case Management Institute Apply a Powerful Depression-Screening Solution to Improve Overall Wellness of Its Members. The Challenge Quality Improvement goals play a key role in the longevity of healthcare organizations. From massive undertakings such cost containment strategies to the more detailed objectives that include implementing targeted approaches to improve health literacy,…

Recently, the International Foundation of Employee Benefit Plans (IFEBP) published the results of an employer survey that sheds light on how COVID-19 has been affecting employee benefits. The Employee Benefits in a COVID-19 World: April 2020 Survey Report revealed some interesting findings which can help plan sponsors better prepare for the year ahead. Employers Are…

COVID-19 has introduced new costs for plan sponsors. Some of these costs are known.  For instance, approximately 15% of people who become infected with the Coronavirus may require hospitalization. The Commonwealth Fund estimated that by October 31, 2020, the U.S. will spend approximately $24 billion on inpatient COVID-19 care; 0.6% of all projected 2019 national…

From all projections, U.S. employers should expect their healthcare costs to rise in 2021.  Self-insured and fully-insured plans could see their premiums increase between 5-6% according to projections by the consulting firm of Willis Towers Watson.  Factors that will influence their premium increases include: the potential of new COVID-19 waves, the costs of a vaccine…

Utilization management (UM) has proven to be an extremely valuable tool for facilitating prudent medical consumption. When first introduced in the late 1980s at which time fee-for-service models dominated, UM was primarily regarded as a cost-cutting tool. It has since come to be viewed as a means for ensuring the medical necessity of various procedures…