HHS OIG Calls for MA Plans to Provide Care Coordination Beyond HRAs
In a report released on September 10, the US Department of Health and Human Services (HHS) Office of Inspector General (OIG) expressed concerns about how Medicare Advantage (MA) organizations are...
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What Pharma Attacks on 340B Mean for FQHCs and CHCs
By now, you’ve probably read at least a few articles on how the pharmaceutical industry is trying to withhold 340B drug savings from certain health care organizations. If you’re employed by a...
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Preparing for Open Enrollment 2021 with Member Engagement Now
Open enrollment is approaching quickly for payers and their provider networks. It is a tense time of year for these organizations — a time when your membership decides if they are going to renew...
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The Secret Connection Between Patient Show Rate and 340B Compliance
According to the 340B Drug Pricing Program, your Federally Qualified Health Center (FQHC) is entitled to 100% of the reimbursement rate on any 340B outpatient drug prescription your patient fills...
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Why do Transitions of Care Matter?
Our health care system today is fragmented. Providers belong to practices, clinics, hospitals, health plans and other provider networks like Accountable Care Organizations or Clinically Integrated...
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How FQHCs can Capture 340B Prescriptions from Specialist Referrals
Federally Qualified Health Centers (FQHCs) are crucial safety net providers of outpatient care for underserved populations. As defined by the Health Resources and Services Administration, FQHCs...
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Top 6 Capabilities Care Management Solutions Offer that “Zoom for Telehealth” Can’t
When telehealth rules were relaxed in March 2020 to allow virtual visits over common smartphone apps like Zoom and FaceTime during the COVID-19 pandemic, patients and providers alike breathed a...
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Should I Manage Referrals in an EMR or Another System?
At ReferWell, we often hear the question, “Can’t my EMR do referrals?” The likely short answer is “Yes” — but with some major caveats that you should consider. Let’s look at what a typical...
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The True Cost of ACO Patient Leakage
Accountable Care Organizations (ACOs) — the providers, health systems and their supporting payer networks who join forces to achieve better quality care and lower healthcare costs — are...
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Payer Strategies In The Time of COVID-19, part 3
This is the third part of a three-part series on strategies for payers during the COVID-19 pandemic.
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