Medicare Advantage Audit Expansion: What Health Plans and Providers Need to

The Medicare Advantage (MA) landscape is seeing a sea change as the Centers for Medicare & Medicaid Services (CMS) implements a significant audit expansion initiative. The CMS Medicare Advantage audit expansion is more than a bureaucrat's tweak—it's an unmistakable sign of the government&#... View More

Chronic Care Management Program: Design & Successful Implementation

In one of the rapidly evolving health care environments in the United States, the management of chronic diseases such as diabetes, hypertension, heart failure, and COPD is one of the most challenging tasks. With close to six out of every ten Americans being affected by at least one chronic condition... View More

Hospice HOPE Assessment Tool: Compassion Through Compliance

In hospice, accuracy and tact are both foremost among priorities, and patient need instruments can make a considerable difference in quality of life for the days remaining. Among required advances is the HOPE Tool —a standard assessment tool created by the Centers for Medicare & Medicaid Services ... View More

Patient Survey - How and When to Use Them

In today's health care climate, the patient's voice is greater than a comment—it's an influential force that can be wielded to increase care quality, optimise practice operations, and stay in compliance with managed care requirements. Among all the methods for hearing that voice, there... View More

Credentialing 103 - 2025

Credentialing is more than a bureaucratic hurdle—it's the lifeline of healthcare operations. Whether you’re a medical practice manager, credentialing coordinator, or part of a hospital's administrative team, you’ve likely felt the pressure of delayed provider onboarding. The year 2025 ... View More

Swing Bed Requirements in 2025

The healthcare market continues to evolve, and 2025 swing bed needs will introduce significant reforms for hospitals, long-term care facilities, and skilled nursing facilities. As more complex patient needs continue to challenge healthcare, the regulatory agencies persist in revising swing bed regul... View More

Pain Management in Orthopedics Surgery

Orthopaedic surgery commonly involves correcting musculoskeletal trauma, degenerative disease, and deformity. While these procedures enhance quality of life and return function, pain after surgery is a daunting challenge to manage. Optimizing pain in orthopaedic surgery makes patients more comfortab... View More

Understanding New HIPAA Security Requirements: A Compliance Guide for Provi

The healthcare industry in the United States is transforming day by day, and with it come the regulations that protect the information of patients. The Health Insurance Portability and Accountability Act (HIPAA) has been the backbone of patient confidentiality and data safeguarding for years. But wi... View More

This information not only provides healthcare professionals with more streamlined processes but also prevents patients who are suffering from waiting for required therapies

Identify Which Insurance Payers Require Prior Authorizations 2025

In the ever-changing healthcare environment, the Prior Authorization Process for Medical Providers is still an essential but sometimes maddening part of patient care. In planning for the future of 2025, it is more important than ever to know which insurance payers have prior authorisations. This inf... View More

What Is Provider Credentialing?

As the healthcare industry keeps expanding, ensuring that patients receive the best quality of care available is crucial. Among the most crucial steps that allow this to be possible is provider credentialing, a phrase that sounds like bureaucratese but has a solid basis in patient trust and safety. ... View More

How to Be a HIPAA Compliance Officer?

Patient confidentiality is more important now than ever in the healthcare setting. HIPAA is the gold standard of discreet patient management of sensitive patient information, and healthcare organizations need highly skilled professionals to guide compliance on their behalf. HIPAA compliance and prot... View More

Learn Best Practices for Charge Capture to Ensure All Services Are Billed C

In the ever-evolving landscape of healthcare, revenue integrity and charge capture have become critical components of financial success for healthcare organizations. Ensuring that all services are billed correctly is not just about compliance; it’s about maintaining trust with patients, optimizing... View More