By now the healthcare industry and every stakeholder knows that the pandemic’s impact will be felt indefinitely. However, with escalating numbers of unemployed, and uninsured, I’ve received countless emails from colleagues and our Monitor Mondays listeners asking about how the payers are stepping up? What’s the status of Medicaid expansion? How are payers assuring patients get their basic human needs addressed? Pre-COVID-19, the financial impact of NOT addressing assessment of, and intervention with the Social Determinants were concerning enough. There was a massive hemorrhage of dollars, which are continuing to drain as you read this article. Patient outcomes were already challenged, and hundreds of hospitals were on the verge of closure, especially those across rural communities.
Here’s a current broad swipe of relevant payer efforts:
As of July 1, 38 states (including District of Columbia) have adopted Medicaid expansion, 13 states have not. The Kaiser Family Foundation has actively tracked state expansion activity, with an interactive map and grid of all state programs and benefits available at www.kff.org. The most recent states include Idaho, Utah, Nebraska (implementation 10/2020), and Oklahoma (implementation targeted for July 1, 2021, if not before. Since the pandemic began, more than 20 million new Medicaid applicants have hit the rosters, 1.5 million over last month alone. Many of these persons are in states without expansion, and with among the highest rates of COVID transmission including Florida, Georgia, Missouri, Mississippi, and Texas. New estimates have global unemployment expected to hit 80 million by the end of 2020, close to 50 million in the US alone.
Medicare Advantage beneficiaries have doubled in the past decade, finalizing requirements last month to increase telehealth access (up to 80% of plans), with:
Managed Medicaid also focused on the expansion of telehealth for all intervention, especially for behavioral health, including substance abuse treatment.
Humana is using medical transportation vehicles to deliver food to vulnerable members in Louisiana, and several other states. Blue Cross Blue Shield is bringing care delivery to at-risk communities, such as sending out vans to do Coronavirus testing throughout Oklahoma. CareSource is using its JobConnect platform to link members with employment, offering education and skill-building programs. Several Centene subsidiaries are partnering with community-based organizations to provide access to food and other essential supplies across the states. Gateway health plans have increased their collaboration with community-based organizations to address food insecurity, job training, and education programs, in Philadelphia, Pittsburgh, and throughout Central Pennsylvania.
As the virus rates continue to rise, we can expect to see more individual managed care providers step up to address the social determinants. Assuring access to these necessary services and programs will maximize health outcomes, especially amid the pandemic.
With the virus rates rapidly rising among a majority of states, our Monitor Monday team wanted to check on how organizations are doing with personal protective equipment supplies. The survey results were surprising and concerning. They are viewable here.
Programming Note: Ellen Fink-Samnick is a permanent panelist on Monitor Mondays. Listen to her live reporting every Monday at 10 a.m. EST.
EDITOR’S NOTE Day 3 of the federal shutdown continues. This article by Mark Spivey is part of a special section today published by RACmonitor and
As expected, the federal shutdown began early Wednesday morning. What’s unknown is how long it will continue. Neither congressional Republicans nor Democrats appear to be
Please log in to your account to comment on this article.
Breast biopsy procedures may be clinically straightforward but accurately translating them into compliant billing can be anything but. In this focused webcast, Shawn Blackburn, CPC, CPMA, CIC, CRC, CCS-P breaks down how imaging guidance, lesion count, laterality, and payer expectations all impact how these procedures should be reported. Through clear explanations and real-world scenarios, you’ll gain practical insight into aligning clinical workflows with billing requirements, avoiding common pitfalls, and ensuring your documentation supports accurate reimbursement and compliance.
Gain clarity and confidence in OB‑GYN coding with this expert‑led webcast featuring Sherri L. Clayton, RHIT, CSS. You’ll learn how to apply global maternity package rules accurately, select the right CPT codes for procedures and visits, and identify documentation gaps that lead to denials. With practical guidance and real examples, this session helps you strengthen compliance, reduce audit risk, and ensure accurate reimbursement for women’s health services.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Traditional utilization management models can no longer keep pace with regulatory shifts, payer scrutiny, and operational pressures. In this webcast, Tiffany Ferguson, LMSW, CMAC, ACM, ACPA-C, introduces an Adaptive Model strategy that modernizes UM through role specialization, technology-driven workflows, and proactive, team-based processes. Attendees will learn how to restructure programs to improve efficiency, strengthen clinical collaboration, and enhance financial performance in a rapidly changing healthcare environment.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Celebrate Lab Week with MedLearn! Sign up to win one year of our Laboratory All Access Pass! Click here to learn more →
Have a Medicare regulation question you’d love Dr. Hirsch to answer? Now is your chance! CLICK HERE to learn more→
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
