Articles by Industry Expert

Medicare Advantage Poised for Growth – Unfazed by Market Shifts and Critic Concerns

By Cynthia Henry – As the healthcare industry adapts to economic and regulatory changes, Medicare Advantage stands out as a cost-effective model consistently delivering value to beneficiaries. Compared to traditional fee-for-service Medicare, MA excels in financial efficiency and quality outcomes, making it a resilient choice for enrollees and a strategic asset for payers.

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More HIPAA Access Issues

By Matt Fisher – The HHS Office for Civil Rights continues to pursue enforcement actions when alleged non-compliance occurs following a right of access request. Not every settlement provides the same degree of insight or ability to follow OCR’s line of thinking though. That is the case stemming from the latest civil monetary penalty announced by OCR.




What is HEDIS? The Basics, Objectives and Significance

By Amit Shah – HEDIS is a measurement set used to determine the efficacy of a payer to care for its members. The performance data collected through HEDIS assists payers in identifying areas for improvement as well as tracking successes through a measurement set that allows them to be compared to other payers.




Effectively Managing DRG Downgrades with Technology

By Dana Finnegan – DRG downgrades pose a significant challenge for healthcare organizations, directly impacting revenue and creating compliance risks. Effectively managing DRG downgrades is key to maintaining financial health and compliance, and technology plays a critical role in simplifying and optimizing this process.