My areas of expertise include occupational therapy, healthcare, exercise, health insurance, nutrition, mental health, rehabilitation, telemedicine, orthopedics, pediatrics, neurology, and health tech.
Medicaid Members To See Continued Coverage Through Mid-2025
Individuals who currently participate in Medicaid waiver programs are getting an additional year of benefits. CMS made this decision in an effort to boost retention for eligible Medicaid recipients. As a result, the waiver program will now end in June 2025 instead of December 2024.
Last spring, many states started the eligibility redetermination process for their Medicaid members. Since this hadn’t occurred in over three years–the last time being mid-pandemic–it was a lengthy undertaking. How...
Fundamentals for Skilled Nursing (AOTA-approved continuing education course)
With a growing aging population, geriatric care as a whole is becoming more essential to the fabric of our society. This means the United States will see an even greater number of geriatric care centers, such as assisted living facilities (ALFs), skilled nursing facilities, and long-term care facilities (LTC) established in coming years. Each of these practice settings needs qualified healthcare professionals to treat both short-term patients and long-term residents. As a result, occupational therapists (OTs) and certified occupational therapy assistants (COTAs) are in high demand in SNFs.
Essential Metrics for Your Health Plan’s Member Satisfaction
Member satisfaction has always been a strong barometer for health plan success. When looking at commercial payers, the most recent J.D. Power U.S. Commercial Member Health Plan Study found that convenience/accessibility, price, and trustworthiness were the biggest differentiators between low and high-rated health plans.
To obtain a comprehensive picture, J.D. Power reported surveying 35,000 members from 147 health plans located in 22 regions across the United States.
Where are the Gaps?
While...
New Legislation Aims to Prevent Falls and Decrease Opioid Usage in Older Adults
Among those 65 and older, the Centers for Disease Control reports falls are the leading cause of injury deaths and responsible for nearly 3 million emergency department visits each year. The Stopping Addiction and Falls for the Elderly (SAFE) Act was introduced in March to study and reduce the impact of this combined public health threat.
If passed, the SAFE Act would allow Medicare beneficiaries to undergo fall risk assessments performed by occupational and physical therapists through their ...
Treating Individuals with Limb Loss and Limb Reduction (AOTA-approved continuing education course)
There is a range of unique considerations that come along with limb loss, and each of these impacts the occupational therapy plan of care. In cases of acquired limb loss, individuals may experience both physical and psychosocial concerns that impact their occupational performance and ability to engage in therapy. However, individuals with congenital limb loss may also struggle with psychological adjustment when it comes to self-esteem and connecting with others. For this reason, OTs must be informed about both types of limb loss.
The Two-Midnight Rule: Additional Changes Expected for Medicare Advantage Members
This year is bringing even more changes for Medicare Advantage (MA) plans. One of the predominant adjustments is that MA plans will now follow the two-midnight rule. This means members’ hospital stays will be covered if their physician expects they will require inpatient care for two or more midnights. This rule has been in place for traditional Medicare plans since 2014, but it has just become effective for MA plans starting this year.
The two-midnight rule has never been used to determine w...
The Medicare Advantage Playbook for 2025: New Rules, New Opportunities
In early April, the Centers for Medicare and Medicaid Services (CMS) finalized the 2025 Medicare Advantage Rule. This legislation also included changes to Medicare Part D, which covers prescription medications. Many health care organizations were expecting updates surrounding prior authorization, which is a hot topic since proposed federal legislation could speed up the approval process for members. However, there are a range of policy modifications that health plans should be aware of.
One c...
Medicare Advantage Spending Surge: What the 2023 Data Reveals & What Your Health Plan Needs to Know
A review of last year’s data shows a spike in service utilization for members with Medicare Advantage (MA) plans in 2023. This information came from an AHIP survey, which found that total medical expenses in the fourth quarter were up 8.1% compared to the same time in 2022. Year-over-year medical expenses increased between 7.0% and 7.5% in each of the other three quarters. While this survey relayed consistent increases across almost all service areas, those that saw the highest percentage of ...
Moral Distress: Coping with Ethical Challenges In OT Practice (AOTA-approved continuing education course)
Ethics in healthcare is a fundamental topic for providers to be educated on. While many aspects of ethics – both in rehabilitation, healthcare as a whole, and in a general sense – do not change, ethics tends to be a nuanced topic. This is partially because ethical scenarios do not always have an obvious solution. At times, providers may even find that many possible courses of action are associated with their unique drawbacks. For this reason, ethics and moral distress are closely related. Both moral distress and ethics are influenced by organizations, payors, societal trends, and more.
Rehabilitation Techniques for Paralysis from Stroke, SCI or TBI
Rehabilitation Techniques for Paralysis from Stroke, SCI or TBI
Paralysis treatment is one area within the healthcare industry that necessitates the use of specialized rehabilitation techniques. There is a particularly substantial evidence base to support the interventions therapists use to address paralysis. Many of these are aimed at improving upper extremity function, increasing mobility, and preventing further injury.
An individual may experience paralysis as a result of a cerebrovascular...
Sensory Intervention: Does it Have a Biological Evidence Base? (AOTA-approved continuing education course)
Many professionals outside of the occupational therapy world are deterred when they hear the words ‘sensory processing.’ Yet, the reality is that sensory processing has a major impact on the work occupational therapists do. Regardless of whether or not a therapist uses sensory integration techniques and modalities with a patient, the inner workings of the sensory system will influence a person’s motivation, performance, affect, and engagement. In some cases, it’s important for an occupational therapist to address a patient’s sensory factors.
Inaccurate Reports of Vaping History Impacting Health Insurance Premiums
Vaping has been highly criticized due to its negative health effects, especially as the Food and Drug Administration (FDA) has cracked down on banning flavored e-cigarette products. As vaping use has increased among adolescents and young adults over the past decade, experts are seeing the impact this habit has on costs within the health insurance industry.
It’s Costly to Not Report Vaping
Under the Affordable Care Act (ACA), health insurers can impose tobacco surcharges for members who report...
Proposed Federal Legislation Intended to Expedite Prior Authorization Approval Process
Recent legislation proposed by the Biden administration aims to address member dissatisfaction with insurance approval wait times. If passed, this rule will apply to prior authorization requests through government insurance plans and could go into effect starting in 2026 for Medicaid and Medicare members.
Prior Authorizations Associated with Cost Savings
In previous years, some experts have contentiously debated the utility of prior authorizations since they often lead to more paperwork for p...
Safeguard Your Pharmacy Reimbursement and Avoid Audits
With ongoing medication shortages and astronomical costs for specialty drugs, nearly all members can benefit from medication savings. Furthermore, managing costs helps payers keep reimbursement rates steady for their partners. TOG has identified several tools that can help with cost-saving efforts.
Leverage proof-of-delivery for medication transport
Proof-of-delivery is just one tool payers can use to enhance security for members receiving medications in the mail, which undoubtedly improves m...
Exploring the Untapped Potential of Effective Provider Network Management for Health Insurance Executives
Navigating the intricate dance of network adequacy, provider relationships, and regulatory compliance can feel like a continuous tightrope walk. These responsibilities are crucial for member satisfaction and organizational health, yet they often need to be juggled alongside pressing deadlines and competing priorities. However, effective provider network management emerges as a powerful tool in the repertoire of astute health insurance executives.
Unlocking Value Through Health Care Provider N...