S. Merritt Beaver

22.65M people notified in the Aflac breach—this isn’t just “oops, a spreadsheet leaked.” It’s the full identity puzzle box: SSNs, driver’s licenses, passports/state IDs, DOBs, addresses… plus medical + health insurance data. That combo is basically fraud on hard mode—*for victims*, not criminals. What to be concerned about: - **Longevity of risk:** SSNs and ID numbers don’t “reset” like passwords. - **Medical identity theft:** claims, prescriptions, and benefits abuse can trail you for years. - **Industry-wide targeting:** filings suggest a **known cybercriminal group** aiming at insurers broadly—think repeatable playbooks, not one-off luck. - **Notification lag = attacker head start:** when scale is this large, “time-to-notify” matters. Worth a read: https://lnkd.in/gBDP-weX #cybersecurity #databreach #infosec #privacy #identitytheft #healthcaresecurity #insurance #riskmanagement #cybercrime Security is a streak you can’t afford to break.

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What do all health plans have in common? They all rely on accurate data for risk adjustment, reimbursement, and patient-centered care. Explore the payer journey and how MRO simplifies the critical data collection process in our latest blog: https://okt.to/fcJSj2

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It was great to talk at HLTH Inc. USA about how we're moving from operating tools to supervising intelligent systems in the revenue cycle. This is the next step in a long productivity journey, shifting our teams from "assistance" and "operate" to "supervise." The complexity of medical coding—with its near-infinite combinations of ICD-10 codes and payer rules—can't be solved by brute force. It requires a new approach. We're developing agentic AI that uses a combination of purpose-built neural networks and tuned LLMs to make decisions within a "capture-to-code" workflow. These agents can determine if a claim is ready for billing and can be sent straight through to the EMR. Or they can intelligently flag a record for documentation clarification or expert review, preventing denials before they happen. It's about empowering our teams with systems that don't just automate tasks but make informed decisions. #HLTHUSA #AIHealthcare #RevenueCycle #Solver LinkedIn profile(s) to tag (highlighted in red):  HLTH Inc. Solventum Travis Bias

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CMS just defined how value-based care will actually operate. Not in guidance. In infrastructure. They released the ACCESS Model API framework. It looks technical. It is not. It is the mechanism that connects eligibility, attribution, outcomes, and payment into a single continuous workflow. The model is simple: Screen → Enroll → Report → Manage Miss a step, miss payment. But the signal is deeper than the sequence. For the first time, CMS is requiring that participation be proven across time, not documented after the fact. Here is what that changes: Before enrollment, you must confirm the patient qualifies. After alignment, you are accountable for managing them. Within 60 days, you must establish baseline outcomes or lose alignment. From that point forward, you must continuously demonstrate trajectory. Not activity. Trajectory. And CMS is not waiting for retrospective submissions. They are pushing events as they occur. This moves the system from documentation to observability. And it exposes a structural gap across healthcare: Care is continuous. Operational visibility is episodic. EHRs capture encounters. They do not track progression. Care management systems track tasks. They do not prove outcomes. Data platforms aggregate information. They do not operationalize it in time to change the result. So this is not a technical shift. It is an operational requirement. If you miss eligibility, you lose the patient. If you miss reporting windows, you lose alignment. If you cannot demonstrate improvement, the economics do not follow. ACCESS compresses the distance between care delivery and financial performance. That is the signal. This is not CMS testing APIs. It is CMS testing whether organizations can function as continuous systems of care. The ones that win will not be the ones that document best. They will be the ones that can see earlier, coordinate across settings, and demonstrate change over time.

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The best AI for DME and HME isn't being built by tech companies alone. At a recent HME industry panel, a leader explained why: "Subject matter expertise combined with tech equals successful AI." Understanding LCD requirements across hundreds of HCPCs isn't something you can learn from a dataset. Knowing why a payor will reject a claim for missing a specific clinical note - that comes from years of working denials, appeals, and audits. The AI that works in DME isn't the most sophisticated from a pure technology standpoint. It's the AI built by people who've spent decades in the trenches of revenue cycle management, who understand the difference between what documentation says and what payors actually need to see. Subject matter expertise isn't a nice-to-have in healthcare AI. It's the difference between a tool that extracts data and a tool that delivers results. See how decades of DME expertise shapes our approach notablesystems.com

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​Discharge Disposition: The High-Stakes Game of Connect-the-Dots 🕵️‍♀️ ​We obsess over Principal Dx, but Discharge Disposition is also tanking accuracy rates. In modern EMRs, the "Face Sheet" is a ghost and the auto-status field is a liar. If you aren't hunting through the clinical narrative, you're gambling with the Post-Acute Care Transfer (PACT) policy. ​Picking 03 (SNF) instead of 01 or 04 (Custodial) can cost your facility thousands in "per diem" reductions. Conversely, missing a Home Health (06) trigger is an audit magnet. ​🔍 The "Triple Threat" Triangulation You can't find the truth in one tab. You must reconcile: ​Discharge Orders: Check ancillary orders! If there’s an order for a SNF but no "Skilled" necessity, you have a conflict. ​Case Management Notes: The "real story." CMs track bed availability and level of care. They’ll state if a patient was rejected for Rehab and sent to a long-term care (custodial) bed instead. ​Discharge Summary: Does the narrative match the destination? If the MD says "Stable for home" but the patient ends up in a facility, investigate. ​🧩 The Custodial Conundrum Sending a patient to a nursing home for residential care? That’s 04 (Intermediate) or 01 (if they live there)—NOT 03. The Trap: Code 03 triggers a PACT reduction. If the SNF doesn’t bill a matching "Skilled" claim, you just lost money for a transfer that didn’t technically happen. (Sources: AHA Coding Clinic Q1 2017; CMS Pub. 100-04, Ch. 3). ​🚩 2026 Pro-Tips ​The 3-Day Rule: HH (06) must start within 3 days and relate to the hospital stay. ​The Resident Factor: Returning to a nursing home without new skilled orders? That’s an 01, not an 03. ​Query Power: MDs use "SNF" as a catch-all for "anywhere but here." If PT/OT says "long-term placement," query it. ​The Motto: Trust the Narrative, Not the Field. Validate your DRG against the PACT list and read those Social Work entries! ​What’s your "go-to" EMR section for verifying a tricky disposition? 👇

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