Blog

The Centers for Medicare and Medicaid Services (CMS) has proposed a new rule that aims to speed up the initial authorization process and improve interoperability in the US healthcare system. CMS Proposed Rule 2023 would require specific payers, including Medicare Advantage organizations, to use prior electronic authorization and to respond to requests within 72 hours...Read More

Healthcare costs are already skyrocketing and creating a challenging crisis for the industry. The disparities in the U.S. healthcare system forge an unnecessary rise in costs that spreads over society, resulting in a financial crisis. The continuing upward trend in costs could lead to an even more significant number of unaffordable bills and deteriorating health...Read More

Risk adjustment has incentive insurance companies to provide memberships to patients who need it the most by “adjusting” the risk of enrolling chronically ill people along with healthier patients, ensuring that providers are adequately compensated according to each patient’s underlying health patterns, and the care provided. To ensure a mutually beneficial risk adjustment program, payers...Read More

Even though the Social Determinants of Health (SDoH) and health equity have received a great deal of interest from the healthcare industry in the recent years, the Biden administration is overhauling the contentious Direct Contracting Model to include additional conditions aimed at addressing the health equity model of accountable care and assuaging progressive legislators’ worries...Read More

Primary Care First (PCF) intends to increase primary care professionals’ self-governance by providing more operational adaptability and performance-based incentives, allowing them to customize care delivery depending on their specific patient groups and resources. The concept actively encourages providers to invest additional time with patients and offer coordinated, effective care by connecting health outcomes for patients...Read More