Jonathan Barnes

Must-know for Medicare open enrollment: the $2,100 cap, smoothing — and the self-administered drug trap Open enrollment runs Oct. 15 - Dec. 7. Your 2026 playbook needs three pivots that hit adherence, scheduling and cash flow. A real ceiling on drug spend 🔹 Part D out-of-pocket costs cap at $2,100 in 2026, up from $2,000 in 2025. After patients hit it, they owe $0 for covered Part D drugs — fewer catastrophic drop-offs in oncology, rheum, neuro and transplant. 🔹 Smoothing kills sticker shock Patients can opt in to pay $0 at the counter and spread cost share into predictable monthly bills. Plans pay pharmacies, then bill members — a financing mechanism, not a discount. Train teams now. 🔹 The overlooked budget bomb Self-administered drugs pulled from facility stock in a hospital outpatient department aren’t covered by Part B and Part D can’t be billed in real time. Result: the patient may pay the hospital, then submit to Part D for reimbursement. That time gap drives abandonments and bad debt. Tighten pre-service counseling. Clinic to-dos before Jan. 1 • Refresh PA rules and formulary paths for your top MA-PD plans • Script staff on the $2,100 cap and smoothing enrollment • Pre-run benefits for high-cost starts and line up on-pathway alternatives • Capture product-level plan data at scheduling, not at check-out • Pharmacies or MID providers are required to notify participants of this program if they have a prescription that costs more than $600 per fill. Watchouts • Smoothing applies only to covered Part D drugs. If a denial is overturned on appeal, then it counts toward the cap. • Past-due balances can block re-election when switching within the same sponsor — don’t promise automatic eligibility. Patients must opt into the program directly through their specific Part D plan. They can do this by visiting the plan's website, calling them directly, or submitting a paper request form, but there is no single national application. Like, comment and share this information – let’s all be prepared.

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I love everything about this. When we get MRX1 CBD oral solution for the treatment of pain associated with endometriosis approved it will be no-brainer for employers to offer it direct to women employees via one of these schemes. Bring on the future of regulatory approved, accessibly priced therapeutics. Ananda Pharma Ltd Andy Rust

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How Can CMOs Use Rhodium to Increase MedSpa Bookings and Boost Revenue? Missed calls become missed revenue. Unlinked EMR, CRM, ads, and scheduling hide which campaigns and providers actually drive value. Reactivation goes manual and slow. Rhodium unifies EMR, CRM, phone, scheduling and ad reporting into a single revenue engine that automates capture, two-way SMS, smart reminders, tiered memberships and ML-driven campaigns. It keeps humans in control while reducing manual friction. You see fewer no-shows, more rebooked slots, and clearer service-level ROAS. Case studies show bookings moving from about $6K to $25K monthly, no-shows falling up to 40 percent, and single ads returning $3,500 plus when you target by treatment and provider. Transformation playbook you can deploy now: 1. ➩ Capture and convert immediately. Set up missed-call capture and a universal inbox with two-way SMS so inquiries are handled in minutes, not hours. That quick response converts a higher percentage of leads and reduces front-desk firefighting. 2. ➩ Reactivate lapsed clients with precision. Launch smart campaigns that use past purchase history to personalize offers. Reactivations often deliver thousands in recurring monthly revenue with minimal ad spend. 3. ➩ Build membership tiers for retention. Create 2 to 3 membership levels with recurring billing and VIP tagging. Members visit more often and spend more per visit. 4. ➩ Optimize scheduling and lower no-shows. Use intelligent reminders and dynamic confirmations to reclaim blocked capacity. That improves utilization and reduces wasted provider time. 5. ➩ Measure and reallocate ad spend by service. Use service-level revenue reporting to stop guessing and double down on high-return creative and dayparts. You save ad dollars and scale winners faster. This is not about another tool, it is about replacing guesswork with a revenue-first platform you can pilot fast. → If you want measurable lift, run a 90-day test with clear KPIs and a 15-minute ROI review. Stop treating missed calls as inevitable; they are the cheapest lost bookings you can recover. Stay tuned for more exciting realtime updates, knowledge tips, and career opportunities. Follow us here. #MedSpa #AestheticsMarketing #HealthcareMarketing #SaaS

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🌎 Credentialing Across America 📍 South Carolina 📆 MSP Thursday 🔎 Presented by Advanced Quality Compliance & CVO 💥 Medical Staff Professionals: The Hidden Powerhouses of South Carolina 💥 They’re the first to verify. The last to sign off. And the only ones making sure your doctor isn’t a walking lawsuit. 🧠⚖️ Meet the MSPs of South Carolina — a fierce, credential-checking, regulation-reading tribe of professionals who protect patients, hospitals, and reputations every single day. 🧠 SCAMSS (South Carolina Association of Medical Staff Services) – the state’s NAMSS affiliate, building up MSPs from hospitals to telehealth groups. 👑 Leaders like: Toni Clark, CPCS – Credentialing Services Manager at RLDatix Caroline Thornton – Credentialing Integrations Boss at Radiology Partners Debbie Branham , CPCS – Managing the MSC at Lexington Medical Annette Pelfrey, CPCS – Prisma Health since 1994 (yes, ma’am!) Danielle Hollingsworth, CPCS – Senior Product Queen at RLDatix These aren't admins. They’re gatekeepers to the profession. 🛡️ What MSPs in SC Actually Do: ✅ Verify every provider’s education, license, board status, and disciplinary history ✅ Maintain files that pass TJC, NCQA, AAAHC, and HRSA audits like pros ✅ Ensure every appointment and reappointment meets state/federal rules ✅ Balance the chaos of multi-site coverage, telehealth, and system mergers ✅ Keep your favorite doctor from being Credentialing Chronicles LLC's next headline ✨ Certified & Credible 🎓 CPCS – The gold standard for credentialing. 🎓 CPMSM – For leadership-level MSPs overseeing it all. South Carolina has both—and they’re leading credentialing offices across MUSC, Lexington, Prisma, RLDatix, and more. 💡 Why It Matters Without MSPs? You’d have unverified providers, failed audits, delayed patient care, and lawsuits lining up like it’s Black Friday. With MSPs? You get quality. Safety. Speed. And sleep at night. 📣 Today, we shout out South Carolina’s MSPs — for protecting patients, providers, and every credentialing file like it’s sacred. Because it is. 🖋️ Presented by: Advanced Quality Compliance and Cvo – the only woman-owned NCQA-certified CVO delivering concierge-level support for privileging credentialing and Payer enrollment across America. Follow us → Advanced Quality Compliance and Cvo or Credentialing Chronicles LLC on LinkedIn, Facebook, TikTok

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I feel like the reaper is heading towards the world of consultant/broker commissions next. In the last week, I’ve had more conversations about broker fees, overrides, contingency payments, and PBM compensation than at any time in the last year. If you are a consultant doing the right thing, getting paid fixed fees for reasonable services, stripping commissions out of your products and transparently helping your employers, I think you’re in a position to do extremely well in the next couple of years. If you sell a bunch of voluntary benefits, pet insurance and prepaid legal to employers, the party may be winding down real soon… Neil Larson FYI

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