Hall Render

FEBRUARY 22, 2024

In the FY 2024 IPPS Final Rule (the “Final Rule”), the Centers for Medicare & Medicaid Services (“CMS”) incorporated certain social risk factors into the Hospital Value-Based Purchasing (“VBP”) Program (“the Program”).

Hospitals 66

Hospitals Medicare Medicare Medicaid 66

Innovaare Compliance

OCTOBER 31, 2023

Every October, with the release of CMS Medicare Advantage Star ratings, millions remember the famous Heraclitus quote (Greek philosopher): “Change is the only constant in life.” The post 2024 Medicare Advantage and Part D Star Ratings: Key Observations and Takeaways appeared first on Inovaare.

Medicare 52

Medicare Medicare Compliance 52

Healthcare Law Blog

JANUARY 26, 2024

On December 13, 2022, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule, titled Advancing Interoperability and Improving Prior Authorization Processes (“Proposed Rule”), to improve patient and provider access to health information and streamline processes related to prior authorizations for medical items and services.

US Department of Health and Human Services 52

US Department of Health and Human Services Medicare Medicare Medicaid 52

Health Care Law Brief

APRIL 3, 2023

On Friday, March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ( Rate Announcement ). 1395w-23): Medicare Advantage Organizations (MAOs) are paid a base rate by CMS. Risk Adjustment.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Innovaare Compliance

NOVEMBER 29, 2023

On October 13, 2023, the Centers for Medicare & Medicaid Services (CMS) published the Readiness List for CY 2024. This has been a very useful tool for Medicare Advantage Organizations (MAO) to check their readiness to fulfill requirements in the new contract year.

Medicare 52

Medicare Medicare Compliance Medicaid 52

Hall Render

JULY 25, 2023

A new mandatory bundled payment model is likely on its way in 2026, and the Center for Medicare & Medicaid Innovation (“CMMI”) is seeking input on how to structure the model to work for existing population-based models, including accountable care organizations (“ACOs”). Comments must be submitted by August 17, 2023.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Hall Render

AUGUST 11, 2023

On August 7, 2023, the Centers for Medicare & Medicaid Services (“CMS”) released a final rule (“Final Rule”) that updated Medicare payment policies and rates for skilled nursing facilities (“SNFs”) under the Skilled Nursing Facility Prospective Payment System (“SNF PPS”) for fiscal year (“FY”) 2024.

Nurses 40

Nurses COVID-19 Vaccine COVID-19 Payment Systems 40

Hall Render

MAY 30, 2023

On April 4, 2023, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule (“Proposed Rule”) that would update Medicare payment policies and rates for skilled nursing facilities (“SNFs”) under the Skilled Nursing Facility Prospective Payment System (“SNF PPS”) for fiscal year 2024. CMS sees this as a 3.7%

Nurses 40

Nurses COVID-19 Vaccine COVID-19 Medicare 40

HIT Consultant

FEBRUARY 9, 2023

Czekai, MPH, VP of Strategic Partnerships at Cohere Health The Centers for Medicare & Medicaid Services (CMS) recently proposed a new rule to advance interoperability and improve the prior authorization (PA) process for Medicare and Medicaid patients. LinkedIn – [link].

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Medicaid Medicaid Medicare Medicare 98

Healthcare IT News - Telehealth

MARCH 25, 2024

The Centers for Medicare and Medicaid Services just released data on its Acute Hospital Care at Home initiative , which thus far has admitted 11,159 patients suffering from respiratory infections, heart failure and severe sepsis. This is largely driven by an aging population and increasing preferences for care in familiar surroundings.

Hospitals 161

Hospitals Health Outcomes Medicaid Medicaid 161

CMS.gov

OCTOBER 2, 2018

Modernizing Medicare to Take Advantage of the Latest Technologies. Administrator, Centers for Medicare & Medicaid Services. Modernizing Medicare to Take Advantage of the Latest Technologies. economy, and by 2026 the CMS Office of the Actuary projects that one in every five dollars spent in America will be spent on healthcare.

Medicare 44

Medicare Medicare Payment Systems FDA 44

C&M Health Law

DECEMBER 23, 2022

The regulations impact CMS-regulated payers and provide incentives for providers and hospitals that participate in the Medicare Promoting Interoperability Program and the Merit-based Incentive Payment System (MIPS). Most of the Proposed Rule’s provisions will be effective on January 1, 2026. Our initial takeaways are summarized below.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Healthcare IT Today

MAY 5, 2023

The following is a guest article by Erin Rutzler, Vice President of Fraud, Waste, and Abuse at Cotiviti In Delaware, more than 250 Medicare patients underwent unnecessary genetic testing based on telehealth consultations that often lasted less than two minutes— costing Medicare thousands of dollars per patient.

Fraud 62

Fraud Medicare Medicare Overpayments 62

Hall Render

MARCH 20, 2024

The Final Rule also imposes additional reporting requirements under the Medicare Promoting Interoperability Program for eligible hospitals and critical access hospitals and for eligible clinicians reporting under the Promoting Interoperability performance category of the Merit-Based Incentive Payment System.

Medicare 40

Medicare Medicare Health Insurance Medicaid 40

Health Populi

FEBRUARY 14, 2018

Three factors will drive healthcare costs to 2026: prices for medical goods and services, changes in income growth, and shifting enrollment from private health insurance to Medicare — driven by the aging of Boomers. trillion in 2026 when healthcare spending will be $1 in every $5 in the American economy (approaching 20%).

Health Insurance 79

Health Insurance Medicare Medicare Medicaid 79

Medisys Compliance

APRIL 18, 2022

In October 2021, the Center for Medicare and Medicaid Innovation (CMMI) announced a goal of having every Medicare beneficiary and the majority of Medicaid beneficiaries covered by some type of alternative payment model (APM) by 2030. In order to do so, a clinician must be in a Medicare Advanced APM.

Medical Billing 52

Medical Billing Medical Billing Outsourcing Medicaid Medicaid 52

Healthcare IT Today

OCTOBER 12, 2023

The Centers for Medicare & Medicaid Services (CMS) have taken a bold step by mandating a standard for prior authorization. I talked to Nikki Henck, Senior Director of Utilization Management at Sagility , about the implementation and potential impact of this proposed requirement, which, if finalized, will be enacted in January 2026.

Electronic Medical Records 107

Electronic Medical Records Doctors Governance Medicaid 107

Medisys Compliance

JULY 27, 2022

For dates of service on or after calendar year 2030, Medicare waives the coinsurance. In the CY 2017 PFS Final Rule, the Centers for Medicare & Medicaid Services (CMS) modified coding and reporting of procedural services that include moderate sedation as an inherent part of the service, including for screening colonoscopies.

Medical Billing 52

Medical Billing Medical Billing Outsourcing ACA Medicare 52

Healthcare Law Blog

DECEMBER 15, 2022

The Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule , “Advancing Interoperability and Improving Prior Authorization Processes” (the “Proposed Rule”), that is intended to improve patient and provider access to health information and streamline processes related to prior authorization for medical items and services.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Healthcare IT Today

FEBRUARY 20, 2023

By 2026, Oak Street Health will have over 300 centers, each of which has the potential to contribute $7 million of Oak Street Health Adjusted EBITDA at maturity, representing more than $2 billion of Oak Street Health embedded Adjusted EBITDA at that time. And we do it all with heart, each and every day. Follow @CVSHealth on social media.

Medicare 88

Medicare Medicare Nurses Health Outcomes 88

Health Populi

SEPTEMBER 27, 2023

healthcare spending, with curves moving up and to the right, and the Medicare Hospital Insurance Trust Fund moving into the opposite direction toward insolvency by 2033. For this discussion, I’ll pick six exhibits from the Report’s roughly 140 exhibits — starting with the big picture of the unsustainable nature of U.S.

COVID-19 96

COVID-19 Medical Billing Health Care Access Hospitals 96

Healthcare IT Today

JUNE 7, 2023

In the comments that we will submit to ONC on HTI-1, we’ll also be encouraging ONC and the Centers for Medicare and Medicaid Services (CMS) to work more closely together to address the misalignments that frequently occur between when ONC tells software developers to deploy new certified versions and when CMS requires providers to be using them.

FDA 89

FDA Compliance Regulatory Compliance Medicaid 89

Hall Render

JULY 14, 2023

On Friday, June 20, 2023, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2024 Home Health Prospective Payment System Rate Update (“PPS Rule”), which has since been published in the Federal Register and is currently open for comment.

Medicare 52

Medicare Medicare Payment Systems Governance 52

HIT Consultant

FEBRUARY 21, 2024

Don Rucker, MD – Chief Strategy Officer, 1upHealth CMS and Medicare are trying to change the dynamics of American healthcare. For the last 20 years, Medicare Fee for Service has been the hotspot of spending and value. Now fast forward to today and Medicare Advantage has more beneficiaries.

Medicare 52

Medicare Medicare Doctors Medicaid 52

Health Populi

JUNE 13, 2018

Even with moderating medical trend growth, the Centers for Medicare and Medicaid Services (CMS) expect that healthcare spending will account for 20% of the U.S. economy by 2026. As with public sector healthcare spending (“entitlements” in the form of Medicare and Medicaid), healthcare spending crowds out U.S.

Medicaid 63

Medicaid Medicaid Health Insurance Medicare 63

Health Care Law Brief

FEBRUARY 8, 2024

Medicaid Managed Care Provisions : Finally, Governor Hochul’s proposal would reform Medicaid Managed Care by: Creating a state procurement process for all Medicaid Managed Care Organizations (MMCOs), including managed long term care plans; Removing the 1% across-the-board administrative rate increase provided to all MMCOs in the FY 2022-2023 budget; (..)

Medicaid 52

Medicaid Medicaid Nurses Licensing 52

CMS.gov

OCTOBER 2, 2018

Administrator, Centers for Medicare & Medicaid Services. annually over the next 10 years to reach over $1 trillion by 2026. Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Jeremy.Booth@c…. Tue, 10/02/2018 - 15:36. Seema Verma. Medicaid & CHIP.

Medicaid 40

Medicaid Medicaid Fraud Health Outcomes 40

HIT Consultant

DECEMBER 8, 2021

between now and 2026. In 2018, the Centers for Medicare and Medicaid Services kicked off its first AI Health Outcomes Challenge , a cross-industry competition to innovate how AI can be implemented in current and future healthcare models.

FDA 52

FDA Health Outcomes Medicaid Medicaid 52

Hall Render

JUNE 22, 2022

On Friday, June 17, 2022, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2023 Home Health Prospective Payment System Rate Update (“PPS Rule”). CMS recognizes a need to smooth these transitions and help to ensure stability in Medicare payments.

COVID-19 40

COVID-19 Payment Systems Medicare Medicare 40

Healthcare Law Blog

FEBRUARY 22, 2023

The Rebate Programs are administered as part of the prescription drug affordability provisions of the Inflation Reduction Act (the “IRA”), which is aimed at “lower[ing] out-of-pocket drug costs for people with Medicare and improv[ing] the sustainability of the Medicare program for current and future generations.” [1]

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Healthcare IT News - Telehealth

AUGUST 28, 2023

The Acute Hospital Care at Home waiver program from the Centers for Medicare & Medicaid Services has grown to 125 health systems and 289 hospitals in 37 states in less than three years. For those who don't know, please describe the Acute Hospital Care at Home waiver program from the Centers for Medicare & Medicaid Services.

Hospitals 103

Hospitals Medicaid Medicaid Medicare 103

Healthcare IT Today

SEPTEMBER 17, 2023

The EHR Association called for greater flexibility in the data completeness threshold and additional criteria to enhance patient matching accuracy, while MGMA called for a positive update to the Medicare conversion factor amid high inflation. East Tennessee Health Information Network chose 4medica to manage duplicate patient records.

Nurses 108

Nurses HIPAA Medicare Medicare 108

Hall Render

NOVEMBER 28, 2023

On November 1, 2023, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2024 Home Health Prospective Payment System Rate Update Final Rule (“2024 Final Rule”), which has since been filed in the Federal Register. CMS is finalizing this proposal. Deactivation.

Medicare 40

Medicare Medicare Payment Systems Medicaid 40

HIT Consultant

JUNE 7, 2023

billion (about $42 per person in the US) per year after paying for the cost of food with most savings occurring within Medicare and Medicaid. She has expertise in Medicaid, Medicare, Social Determinants of Health, and federal/state regulations and their application within payer/provider environments. Over a 10-year period, $185.1

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Healthcare Law Blog

JANUARY 6, 2023

In addition to funding, the Act modifies certain telehealth provisions, expands and extends components of the Medicare and Medicaid programs, and supports initiatives within the behavioral health and substance use treatment spaces. Medicare Extension & Adjustments. reduction of the Medicare conversion factor.

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COVID-19 Medicaid Medicaid Medicare 52

Bill of Health

SEPTEMBER 9, 2022

While this program represented the largest intergovernmental transfer of multipurpose funds in over 40 years, one-time funds discourage elected officials from making investments that will need to be sustained beyond the program’s 2026 expiration date. This precludes rebuilding the decimated public health workforce.

Public Health 362

Public Health COVID-19 Public Health Professionals Governance 362

Healthcare Law Blog

NOVEMBER 13, 2023

On November 6, 2023, the Centers for Medicare and Medicaid Services (“CMS”) released the contract year 2025 proposed rule for Medicare Advantage (“MA”) organizations and Part D sponsors (the “Proposed Rule”). The UM committee was established in April 2023 in the 2024 Medicare Advantage and Part D Final Rule (CMS-4201-F).

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Medicare Medicare Medicaid Medicaid 59