CMS Cracks Down on Medicare Advantage Audits: $43 Billion in Estimated Overpayments Leads to Increased Oversight
CMS’s recent announcement to audit every Medicare Advantage (MA) plan annually marks a major shift in oversight, with a clear focus on ensuring that diagnoses, especially those identified during In Home Assessments (IHA), are fully supported by medical records and documented care. This expansion, which represents a shift from auditing about 60 plans a year to all […]
What the 2× Weight Drop Means for CAHPS and How to Stay Ahead
After years of CAHPS being weighted at 4×, the Centers for Medicare & Medicaid Services (CMS) announced in late 2024 that CAHPS measures would be rolled back to 2× starting in 2026.
Phone Calls for Member Engagement Work! Here’s Why
The consumerization of healthcare is transforming how individuals access and manage their health. Mobile apps, health plan portals, and AI-powered chatbots are at the forefront of this shift, offering personalized, on-demand tools that mirror the convenience of industries like retail and banking. These solutions empower members to take control of their healthcare journey—whether it’s scheduling […]
2025 Outlook: A Year of Innovation, Equity, and Transformation in Healthcare
As we enter 2025, the healthcare industry stands at a pivotal moment shaped by transformative trends from the past year. Advancements in artificial intelligence (AI), escalating healthcare costs, and heightened cybersecurity threats have underscored the need for innovation, resilience, and adaptability. These challenges have also opened the door to meaningful opportunities—to optimize healthcare delivery, improve […]
Unlocking Revenue and Quality Care: How Accurate Risk Adjustment Drives Success in Medicare Advantage
Since the 1980s, Medicare-eligible individuals have had the choice between the traditional fee-for-service plan, where the federal government pays healthcare providers a set fee for each service, and Medicare Advantage (MA), where the government pays private health plans a fixed amount for each enrollee. Today, over half of all Medicare beneficiaries are enrolled in Medicare […]
Stuck in 3-Star Purgatory? How Annual Programming Can Propel Your Health Plan to 4 and 5 Stars
For many health plans, breaking free from a 3-Star rating can feel like an insurmountable challenge. Being stuck in this ratings purgatory not only limits your access to quality bonus payments but also hampers your ability to attract new members and diminish your overall plan reputation. Achieving higher ratings is not just a matter of […]
That’s a Wrap on RISE National 2024!
Last week, thousands of health plans, healthcare providers and healthcare technology executives descended on Nashville to drive spirited conversation around best practices for elevating member satisfaction, matching appropriate risk adjustments with care adherence and improving Star Ratings for Medicare Advantage plans. Over the course of the three-day RISE National Conference, the ReferWell team welcomed the […]
Transforming Member Experience: A Success Story from Select Health
In the dynamic landscape of healthcare, providing an exceptional member experience is paramount. However, achieving this goal can be challenging, especially for large health organizations grappling with complex systems and processes. In a recent podcast episode, we had the privilege of exploring how Select Health, a leading health plan, successfully tackled their member experience issues. Let’s […]
Harnessing Member Data to Schedule and Close Care Gaps
Health Plans can revamp their member outreach and appointment scheduling process to close care gaps faster by using insights gained from member data. Healthcare has invested heavily in data solutions to identify members with open care gaps. Still, plans often struggle to get these members to schedule care gap appointments (for a few reasons). And, […]
A Proven Strategy to Boost Referral Volume and Skyrocket Your Appointment Bookings
ReferWell’s Client Operations Team is often approached by specialty practices, outpatient surgery centers, hospitals, and health systems seeking better ways to increase referral volume. While they have tried digital marketing, they are aware of anti-kickback laws. In that vein, ReferWell has collaborated with Lenox Hill Radiology (LHR), which operates over 70 imaging centers in the […]