Health Populi

JUNE 3, 2020

McKinsey’s report models outpatient and office visits that can be virtually enabled for patients covered by both commercial and public sector health plans (Medicare and Medicaid). The Deloitte report boldly looks forward to 2030 and 2040, imagining that several forms of healthcare will migrate to virtual formats.

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COVID-19 Hospitals Medicaid Medicaid 153

Hall Render

MAY 23, 2023

The Centers for Medicare & Medicaid Services (“CMS”) is now accepting applications from ACOs to participate in the Medicare Shared Savings Program (“MSSP” or “Program”) for the agreement period beginning January 1, 2024. The application process is split into two phases.

Medicare 64

Medicare Medicare Medicaid Medicaid 64

HIT Consultant

APRIL 3, 2023

These risk-based care models are designed to encourage proactive care, better population health and reduced spending across the healthcare spectrum.

Medicaid 98

Medicaid Medicaid Medicare Medicare 98

HealthIT Answers

NOVEMBER 28, 2022

By Liz Fowler JD PhD, Purva Rawal PhD, Sarah Fogler PhD, Brian Waldersen MD MPH, Meghan O’Connell MPH, & Jacob Quinton MD MSHS - In 2021, CMS established a goal to have 100 percent of Original Medicare beneficiaries and the vast majority of Medicaid beneficiaries in accountable care relationships by 2030,,, The post The CMS Innovation Center’s (..)

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Healthcare IT Today

MARCH 27, 2023

billion by 2030, according to Research and Markets Reports. New Payer Coverage and Revenue Cycle Management With 250 million patient lives covered under 600+ of the nation’s top payers, including Medicare, Medicaid and every major private insurer, OpenLoop is also announcing today a new Payer Coverage & RCM service.

Licensing 111

Licensing Health Outcomes Medicaid Medicaid 111

MedTrainer

APRIL 18, 2024

Behavioral health credentialing exploded in 2023 and 2024 as providers could enroll in Medicare for the first time. Download Now Common Challenges in Behavioral Health Credentialing Where behavioral health credentialing diverges from typical provider credentialing is Medicare enrollment.

Medicare 52

Medicare Medicare Licensing Compliance 52

Healthcare Law Blog

MAY 5, 2022

Department of Health and Human Services Office of Inspector (“OIG”) released a report that studied prior authorization denials and payment denials by Medicare Advantage Organizations (“MAOs”) (the “Report”). Thirteen percent of denied prior authorization requests met Medicare coverage rules. The OIG Report. additional test results).

Medicare 52

Medicare Medicare Licensing Health Insurance 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. A number of other health systems and hospitals have secured waivers but haven't yet implemented a program.

Hospitals 143

Hospitals Medicaid Medicaid COVID-19 143

Jane Sarashon

MAY 30, 2024

But to keep building on models for staying at home as we age will require policy changes for public sector programs, such as Medicare and Medicaid, as well as commercial/private sector programs that can support people in aging in novel ways not yet served up in the private sector.

Medicare 75

Medicare Medicare Licensing Hospitals 75

HIT Consultant

FEBRUARY 8, 2024

The Centers for Medicare and Medicaid Services (CMS) intends to shift traditional Medicare and many Medicaid beneficiaries into VBC arrangements by 2030. Value-based contracting rapidly evolves, with federal and state regulatory bodies imposing new mandates.

Medicaid 105

Medicaid Medicaid Medicare Medicare 105

Hall Render

NOVEMBER 29, 2023

On November 2, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued the 2024 Medicare Physician Fee Schedule Final Rule (“Final Rule”) for calendar year (“CY”) 2024. These changes become effective on January 1, 2024. CMS anticipates the changes will increase MSSP participation by 10% to 20%.

Medicare 40

Medicare Medicare Nurses Payment Systems 40

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.

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Medical Billing Medical Billing Outsourcing Medicaid Medicaid 52

Hall Render

JUNE 23, 2023

In the latest effort to increase price transparency and lower prescription drug costs, the Centers for Medicare & Medicaid Services (“CMS”) issued a proposed rule (“Proposed Rule”) that, in part, intends to reveal the actual cost of drugs covered by Medicaid.

Medicaid 40

Medicaid Medicaid Governance Medicare 40

Medisys Compliance

JULY 27, 2022

CMS is planning to gradually reduce this coinsurance until it’s completely free for dates of service on or after January 1, 2030. For dates of service on or after calendar year 2030, Medicare waives the coinsurance. For dates of service calendar years 2027-2029, the reduced coinsurance is 10%.

Medical Billing 52

Medical Billing Medical Billing Outsourcing ACA Medicare 52

Hall Render

AUGUST 6, 2024

The Centers for Medicare & Medicaid Services (“CMS”) released the 2025 Inpatient Prospective Payment System (“IPPS”) Final Rule (“Final Rule”) on August 1, 2024. Background on Rural and Urban Delineations Medicare classifies hospitals by rural and urban status for a variety of payment purposes.

Medicare 40

Medicare Medicare Payment Systems Hospitals 40

Hall Render

AUGUST 6, 2024

The Centers for Medicare & Medicaid Services (“CMS”) released the 2025 Inpatient Prospective Payment System (“IPPS”) Final Rule (“Final Rule”) on August 1, 2024. Background on Rural and Urban Delineations Medicare classifies hospitals by rural and urban status for a variety of payment purposes.

Medicare 40

Medicare Medicare Payment Systems Hospitals 40

Hall Render

MARCH 21, 2024

The Centers for Medicare & Medicaid Services (“CMS”) recently announced the ACO Primary Care Flex Model (“Flex Model”), a new voluntary model within MSSP for low-revenue ACOs, that begins January 1, 2025.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

HIT Consultant

FEBRUARY 10, 2022

This focus also supports critical imperatives from the Centers for Medicare & Medicaid Services (CMS) to improve health equity and have everyone in Medicare fee-for-service aligned to an accountable relationship by 2030,” said Kyle Armbrester, CEO of Signify Health. “We

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Healthcare IT Today

JULY 18, 2024

CareJourney derives market-leading analytics from Medicare, Medicaid, Medicare Advantage, and Commercial claims data across more than 300 million beneficiaries and over 2 million providers nationwide. Payers, providers, and employers can use these actionable insights to accelerate growth and improve performance. .”

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Medicare Medicare Governance Medicaid 78

Hall Render

JULY 7, 2022

The Consolidated Appropriations Act, 2021 (the “Act”) signed into law on December 27, 2020, created a new Medicare provider type called a Rural Emergency Hospital (“REH”). The Act created the new REH Medicare provider type. An REH must provide 24/7 emergency services and certain other outpatient health services.

Hospitals 70

Hospitals Payment Systems Medicare Medicare 70

HIT Consultant

SEPTEMBER 16, 2024

After a patient visit, a healthcare provider typically requires a full administration team to manage data across various systems, just to receive reimbursement from the insurance providers, Medicaid, or patients for the services provided. from 2021-2030, reaching nearly $6.8 trillion by 2030. healthcare spending reached $4.5

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Hall Render

DECEMBER 5, 2022

For more information on this issue or the No Surprises Act generally, please contact: Angela Smith at (317) 977-1448 or asmith@hallrender.com ; Benjamin Fee at (720) 282-2030 or bfee@hallrender.com ; Lisa Lucido at (248) 457-7812 or llucido@hallrender.com ; Matthew Reed at (317) 429-3609 or mreed@hallrender.com ; or.

Medicaid 72

Medicaid Medicaid Medicare Medicare 72

Healthcare Law Blog

DECEMBER 12, 2022

The Centers for Medicare & Medicaid Services (CMS) Innovation Center continues to move forward with its “strategic refresh” initiative. Through this shift, CMS aims to examine and enhance payments for specialty care provided to Medicare beneficiaries. Value-Based Care and ACOs.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

MedTrainer

MARCH 8, 2024

These financial incentives are from agencies such as the Centers for Medicare and Medicaid Services (CMS) and the Health Resource & Services Administration (HRSA) , who are working to achieve health equity and improve public health. FQHCs can participate in APMs through Medicare and Medicaid Managed Care Organizations (MCOs).

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

HIPAA & Health IT

MAY 19, 2023

Ideally, this will manifest in increased interoperability capabilities nationwide—the Centers for Medicare & Medicaid Services has committed to transitioning to value-based arrangements by 2030.

Nursing Homes 52

Nursing Homes Nurses Public Health Medicaid 52

HIPAA & Health IT

MAY 19, 2023

Ideally, this will manifest in increased interoperability capabilities nationwide—the Centers for Medicare & Medicaid Services has committed to transitioning to value-based arrangements by 2030.

Nursing Homes 52

Nursing Homes Nurses Public Health Medicaid 52

HIT Consultant

JUNE 8, 2023

However, insufficient technology to implement value-based care models, a hesitancy to accept financial risk, opposing incentives and no established contract blueprint remain key barriers to adoption.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Jane Sarashon

FEBRUARY 4, 2024

Neither of these explanations satisfies my current view of where I see the industry at this moment, and especially as I work through my forecast to 2030. Retail health-meets-Medicare. This work started in 2023 involving Walmart Health clinics serving Medicare members and looking to partner with UnitedHealth plan members and others.

US Department of Health and Human Services 75

US Department of Health and Human Services Health Insurance Medicare Medicare 75

HIT Consultant

APRIL 12, 2022

The entire Baby Boomer generation will be over age 65 by 2030, meaning 1 in 5 Americans will be of retirement age. Through interpersonal communication and technology, DUOS identifies and addresses the individual needs of older adults by leveraging Medicare benefits, trusted partners, and local service providers.

Medicare 52

Medicare Medicare COVID-19 Health Insurance 52

Healthcare IT Today

JUNE 28, 2024

To meet the ambitious goal of the Centers for Medicare & Medicaid Services (CMS) — covering all traditional Medicare beneficiaries and most Medicaid beneficiaries by value-based providers by 2030 — it’s clear that the entire healthcare field needs to adapt accordingly.

Medicaid 64

Medicaid Medicaid Medicare Medicare 64

Healthcare IT Today

FEBRUARY 28, 2024

This once-in-a-generation evolution will change how healthcare looks and operates over the next 6-12 months with changes lasting through the decade—especially considering CMS is committed to having 100 percent of Medicare and the majority of Medicaid on value-based reimbursement by 2030.

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Doctors Medicaid Medicaid Hospitals 128

Health Care Law Brief

MARCH 8, 2022

On February 24, 2022, the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), announced the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model, which will begin January 1, 2023, and replace the Global and Professional Direct Contracting (GPDC) Model.

Medicare 52

Medicare Medicare Fraud Compliance 52

HIT Consultant

MARCH 17, 2024

The Centers for Medicare and Medicaid Services (CMS) has outlined an ambitious objective: to transition all traditional Medicare beneficiaries into a VBC arrangement by 2030, a notable increase from the mere 7% recorded in 2021 by Bain Research.

Medicare 64

Medicare Medicare Medicaid Medicaid 64

Hall Render

NOVEMBER 20, 2023

On November 17, 2023, CMS published its final rule requiring Medicare and Medicaid nursing facilities to provide more detailed ownership and managerial information. The final rule includes new definitions of “private equity company” and “real estate investment trust” for Medicare enrollment purposes. HCA plans to invest $5.3B

Nurses 40

Nurses Medicare Medicare Medicaid 40

Hall Render

FEBRUARY 20, 2023

More than one year after its effective date, the Centers for Medicare and Medicaid Services (“CMS”) has started investigating consumer complaints alleging provider violations of the No Surprises Act. Assess compliance with the No Surprises Act requirements as part of internal auditing, internal audit, or compliance review practices.

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Compliance Medicaid Medicaid Medicare 40

Healthcare IT Today

SEPTEMBER 19, 2023

I would continue to advance CMS’ directive that by 2030 all Medicare and the bulk of Medicaid beneficiaries be in care engagements governed under a value-based contract.

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Hospitals HIPAA Nurses Governance 139

Healthcare Law Blog

JANUARY 12, 2023

That’s reminiscent of the well-known Medicare Advantage statistic that about 4% of Medicare Advantage members drive 40% of Medicare Advantage total expenses. Given the above, it’s not surprising to see that Medicare is a fast growing line of business for Hinge, as is employer-based business. Thinking Outside the Box.

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Medicare Medicare Doctors Hospitals 52