Compliance & Regulation

New Hospital Accreditation Standards for Health Equity

As the quest for health equity gains momentum, the nation’s oldest and largest healthcare evaluation and accreditation body has announced new standards…

4 Core Competencies for Value-Based Care Success

Value-based care is the future of healthcare in the U.S. These four core competencies can help guide your organization toward a model…

Zeroing In on CMS “Meaningful Measures” Targets

Meaningful Measures 2.0 goals are designed to facilitate the ongoing move toward value-based care, which targets issues including person-centered care, safety, chronic…

Taking Action: How States Are Using Medicaid 1115 Waivers to Address SDOH

These four states are taking a boots-on-the-ground approach to addressing social determinants of health. Subscribe to our blog Don’t forget to share…

Improving Health Plan Star Ratings

When you can align activities such as prior authorizations, utilization management and operational workflows with regulatory mandates for quality, timeliness, interoperability and…

2021 Star Ratings: Bottom-Line Impact and Strategies

The latest episode of Liberation Lab focuses on CMS changes to Star Ratings and what the shift in weights of different measures…

Star Ratings Now Focused on Member Experience

Nancy Green, senior vice president at Aveus, sat down with Julie Barnes, founder of Maverick Health Policy, and Debbie Hill, vice president…

Pandemic Leads to Relaxed Penalties for HIPAA Violations

The U.S. Department of Health and Human Services has prioritized efforts to contain the COVID-19 pandemic over enforcing HIPAA rules.    Subscribe…

Star Ratings and the Need to Improve Consumer Experience

A game-changing revision to CMS rules for Star ratings puts Medicare Advantage plans under extra pressure to deliver an excellent customer experience….

The Prior Authorization Rule and Advancing Utilization Management Performance

The latest episode of Liberation Lab focuses on the prior authorization rule affecting utilization management. Julie Barnes, JD, Founder and Principal of…

What the Interoperability and Prior Authorization Rule Means for the Patient Experience

What does the new interoperability and prior authorization rule mean for the patient experience? Julie Barnes, founder and principal of Maverick Health…

Managing the Appeals Process for Medicaid Populations

The healthcare appeals process can be difficult to navigate. How can we ensure that patients easily understand the process and their healthcare…

Improving Compliance for Medicaid Populations

The COVID-19 pandemic has resulted in more people on Medicaid. It’s more important than ever before for the healthcare industry to do…

Final Updates to Stark Law Will Ease Transition to Value-Based Care

New rules will ease administrative burden, speed up reimbursement and remove fears of accidental violations. Subscribe to our blog Don’t forget to…

Post-Election Healthcare Policy Implications

Liberation Lab turns its sights to the potential implications of the November 2020 election on US healthcare policy. Our expert guests include…

Making Measurable Improvements in Healthcare Quality

Moving forward, Fast Healthcare Interoperability Resources (FHIR) will be used for the digitalization of HEDIS quality measures. Subscribe to our blog Don’t…

Medecision’s Path Toward MARS-E Compliance

In January 2019, Medecision launched a yearlong process to achieve MARS-E compliance. Here’s how we did it. Subscribe to our blog Don’t…

Proposed Stark Law Changes Reflect Move Toward Value-Based Care

In October 2019, CMS proposed changes to the Stark Law, which was enacted in 1988 to prevent physicians from prioritizing financial concerns…

CMS and ONC Interoperability Rules: What Do the Latest Updates and Enforcement Delays Mean for the Industry?

CMS and ONC delays to enforcement give the industry a few additional months to prepare for major overhauls to ensure the appropriate…

Leveraging Utilization Management to Reduce Medical Loss Ratio Rebates

Medical loss ratio (MLR) rebates hit a record $1.3 billion in 2019 because health plans spent too little on medical claims and…

Mitigate Compliance Risks by Addressing These Key Documentation and Billing Challenges for Medicaid Managed Care Plans

More state Medicaid programs are now addressing SDOH through managed care plans and Section 1115 demonstration waivers. However, while these Medicaid programs…

Automating Compliance in the Cloud

In his “Automating Compliance in the Cloud” session during the CTO Roundtable at Liberation 2019, Gerry Miller, the founder and CEO of…

New Rules From CMS Carry Heavy Weight for Payers

In February 2019, the Centers for Medicare and Medicaid Services (CMS) issued new requirements for Medicaid, the Children’s Health Insurance Program, Medicare…

Risk Sharing Requires Health Plans to Hone Utilization Management Process

Healthcare organizations’ success under risk sharing and value-based care relies on a well-oiled UM program. Subscribe to our blog Don’t forget to…

Addressing Social Determinants of Health Can Lead to Better Health Outcomes

Research shows that social determinants of health (SDoH)—such as housing, transportation, access to healthy food and more—are linked to patient outcomes. Managed…

“Utilization Management” is all about saving health plans money. Or is it?

Until recently, Utilization Management was all about how health plans determine preauthorization. But that definition is fast becoming outdated. Subscribe to our…

Utilization management: What’s it got to do with population health?

What does Utilization Management have to do with Population Health? The answer: everything. Subscribe to our blog Don’t forget to share this…

Medecision Launches Aerial UM Connector™ to Drive In-Network Referrals and CMS Reporting Compliance for Government Health Plans and TPAs

SaaS application connects provider contract and member enrollment details for real-time authorizations and referrals, eliminates costs and delays tied to manual utilization…