Healthcare’s Provider Data Challenges

[Sponsored] Provider data issues start at enrollment and continue throughout the provider lifecycle, impacting everything from credentialing to the provider directory. ProviderTrust’s new guide explores this topic. The post Healthcare’s Provider Data Challenges appeared first on MedCity News.

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Waste, Fraud and Abuse – Oh, My!

By KIM BELLARD So the House has passed their “big, beautiful bill,” by the narrowest of margins. Crucial to the bill are large savings from Medicaid, which in past years Republicans would have taken some glee from but now they are careful to explain away as just cutting “waste, fraud and abuse,” having finally realized…

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The GOP’s Budget Plan Is a Crisis in the Making for Hospitals

If enacted, the GOP’s spending bill would kick more than 10 million Americans off Medicaid. Experts are worried about the major spike in uncompensated care that hospitals would have to provide — and they’re warning that this change will result in major revenue losses for hospitals, facility closures, higher premiums for commercially insured patients, and…

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Factors That Increase Utilization Management Risk

That is the title of a new paper published in the American Journal of Managed Care (AJMC) with co-authors Jacob Fajnor, Shurui Zhang, and Donald Nichols. The abstract is below. Objectives: To (1) develop a metric that quantitatively measures the risk that utilization management (UM) policies pose to patients and (2) measure the relationship between…

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