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

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

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

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.

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Medicaid Medicaid Medicare Medicare 98

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

Healthcare IT News - Telehealth

DECEMBER 14, 2021

Caravan Health President and CEO Tim Gronniger previously was chief of staff and director of delivery system reform at the Centers for Medicare and Medicaid Services. In 2019 and 2020, its partners earned $300 million in Medicare savings, more than $120 million in shared savings, and quality scores exceeding 97%, the company reported.

Medicare 163

Medicare Medicare COVID-19 Telemedicine 163

Hall Render

APRIL 12, 2024

On April 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) released the 2025 Inpatient Prospective Payment System (“IPPS”) Proposed Rule (“Proposed Rule”). Background Medicare classifies hospitals by rural and urban status for a variety of payment purposes.

Medicare 40

Medicare Medicare Payment Systems Hospitals 40

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.

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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

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

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

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

Health Populi

JULY 13, 2020

economic outlook for 2020 to 2030 on July 1, 2020. For health care, the data portrayed in the next chart will be concerning: the Medicare and Social Security Trust Funds are expected to hit “zero” (the X-access) by 2025 and just after 2030, respectively. The Congressional Budget Office published an update to the U.S.

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COVID-19 Medicare Medicare Hospitals 106

HIT Consultant

AUGUST 23, 2022

The Center for Medicare and Medicaid Services (CMS) is leading the charge in value-based-care, with recent updates, including the CY 2023 Medicare Advantage Rate Notice to its CY 2023 Physician Fee Schedule (PFS) Proposed Rule.

Medicare 98

Medicare Medicare Medicaid Medicaid 98

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 70

US Department of Health and Human Services Health Insurance Medicare Medicare 70

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.

COVID-19 149

COVID-19 Hospitals Medicaid Medicaid 149

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

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

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

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

JULY 13, 2022

has been driven by the establishment of the Center for Medicare and Medicaid Innovation (CMMI). Recently, CMMI stated that by 2030 every Medicare beneficiary should be in a value-based relationship – either an ACO or ACO-like model or Medicare Advantage – with a significant emphasis on health equity.

Medicare 98

Medicare Medicare Medicaid Medicaid 98

CMS.gov

MARCH 1, 2019

Administrator, Centers for Medicare & Medicaid Services. Medicare Parts A & B. My primary mission as the Administrator of the Centers for Medicare and Medicaid Services (CMS) is to deliver on President Trump’s commitment to strengthen and modernize Medicare for the millions of Americans who depend on us every day. .

Medicare 38

Medicare Medicare Medicaid Medicaid 38

Hall Render

AUGUST 1, 2022

The OPPS Proposed Rule also discusses quality-reporting requirements for REHs, an expedited Medicare enrollment process and REH-specific Stark Law updates. Hospitals may only convert to REHs if they were a CAH or rural hospital with not more than 50 beds participating in Medicare as of December 27, 2020. REH Enrollment Process.

Hospitals 40

Hospitals Payment Systems Medicare Medicare 40

Healthcare Law Blog

FEBRUARY 1, 2023

Congress’s expansion of access to telehealth takes steps to ensure continuity of care for Medicare beneficiaries and provides regulators with additional time to determine which flexibilities will become permanent, indicating a success for the telehealth industry as well as a reminder that there is more legislation to come. from 2023 to 2030.

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Electronic Medical Records Medicare Medicare Health Outcomes 52

Hall Render

DECEMBER 4, 2023

The Centers for Medicare & Medicaid Services (“CMS”) finalized significant updates to the Hospital Price Transparency regulation for the first time since the rule took effect on January 1, 2021. Hall Render blog posts and articles are intended for informational purposes only.

Hospitals 52

Hospitals Compliance Patient Advocacy Medicare 52

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 Hospitals Medicaid Medicaid 112

Healthcare IT Today

JANUARY 6, 2023

Additionally, CMS (Centers for Medicare & Medicaid Services) will repeal the patient data collection requirements needed to bill certain RTM codes, removing a substantial barrier to billing and making it easier to adopt remote monitoring solutions for patient care. And by 2030, all boomers will be at least age 65.

US Department of Health and Human Services 112

US Department of Health and Human Services Doctors Telemedicine Public Health 112

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

Healthcare IT Today

JANUARY 5, 2024

And for all the chatter about meeting CMS’ 2030 VBC deadline, real progress toward meaningfully shifting care models has been difficult to find. Soon, market forces, combined with the looming 2030 deadline, will spur real action. Jake Pyles, CEO at CipherHealth The path to value-based care is anything but a straight line.

Nurses 122

Nurses Medicare Medicare Health Outcomes 122

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

JUNE 14, 2023

On June 8, 2023, the Centers for Medicare & Medicaid Services (“CMS”) announced the Making Care Primary Model (“Model”), a new multi-payor, voluntary primary care model tested by the Center for Medicare and Medicaid Innovation (“CMMI”) and aimed at strengthening the primary care infrastructure for Medicare and Medicaid patients.

Medicaid 40

Medicaid Medicaid Medicare Medicare 40

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

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.

Health Outcomes 100

Health Outcomes Licensing Medicaid Medicaid 100

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.

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Hospitals Medicaid Medicaid Medicare 102

HIT Consultant

JUNE 22, 2022

In 2019 alone, and under the traditional fee-for-service model, Medicare spending on skilled nursing facilities (SNFs) averaged $27.8 As touched on above, post-acute care delivered in the SNF setting accounts for a significant portion of Medicare fee-for-service costs. Optimize skilled nursing facility length of stay.

Hospitals 98

Hospitals Medicare Medicare COVID-19 98

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

Healthcare Law Blog

JANUARY 11, 2022

Morgan Conference – COVID-19, the jittery stock market, the future of Medicare Advantage and recent industry changes. Centene noted that for Centene Medicare members, the inpatient utilization trend was higher than 60%, but lower than 60% for Medicaid and Marketplace members. There are a LOT of shadows over this year’s J.P.

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COVID-19 Medicare Medicare COVID-19 Vaccine 52