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Improve HCC Coding Accuracy and Risk Adjustment

Diagnosis coding is becoming more and more important. The shift from volume to value requires HCC coding for patient acuity not just diagnosis coding for medical necessity.  As the healthcare reimbursement process shifts towards a Value-Based model, Fee-for-Service will [...]


Cost Variation For A Diagnostic Test In Healthcare Industry Affecting Reimbursement

The health care costs in the USA are exceeding considerably by 17% of GDP. Whereas expenditure done by other countries are less but with the same time healthcare cost is in increasing trend. As the population ages, the advanced [...]


Final rule for Medicare Advantage and Medicare Part D plans

The CMS (Centers for Medicare & Medicaid Services) issued a final rule on May 16, 2019 that modernizes and improves the Medicare Advantage and Part D programs. Now patient will have transparency into the cost of prescription drug in [...]


Oncology Care – Precision Medicine Can Lower Drug Cost

There is a lot of connection between the terms “precision medicine” and “personalized medicine.” According to the National Research Council, “personalized medicine” is an older term with a meaning similar to “precision medicine.” Precision medicine is a method to [...]


Success of Pennsylvania Rural Health Model

Rural hospitals provide essential health care services and are pillars of their communities, but many are struggling to stay open. Rural hospitals are facing challenges due to financial instability and a system that dis-incentivizes visionary transformation. Rural hospitals are essential [...]