In response to ongoing opposition from both lawmakers and providers, the Department of Health and Human Services (HHS) recently announced it has made changes to its rules surrounding COVID-19 relief funding. The department’s amended rules now allow providers to use Provider Relief Fund (PRF) money… Read More »HHS Loosens Provider Relief Fund Restrictions, Allows Agencies to Cover Lost Revenue
Vanessa Kuhn, Director of Health Policy, PatientPing The Centers for Medicare and Medicaid Innovation (CMMI) created the Direct Contracting Model to expand opportunities for more diverse providers and healthcare organizations to participate in value-based care arrangements for Medicare fee-for-service (FFS) beneficiaries. The goal of the… Read More »CMS Direct Contracting Model Options for Value-Based Care
Eric Tran, Tulane School of Medicine Donald Voltz, MD, Aultman Hospital The COVID-19 virus is ravaging the planet at a scale not seen since the infamous Spanish Flu of the early 1900s, inflicting immense devastation as the U.S. loses more than 200,000 lives and counting.… Read More »Rural Hospital Execs Can Beat COVID-19 By Shifting From Reactive to Proactive Care
The COVID-19 pandemic has forever changed patient expectations for healthcare delivery, including offered services and health office operations. Although health systems have remained dynamic in adopting telehealth capabilities, their long-term capital, like real estate and supply chain management (SCM) protocols, have not adapted to match… Read More »5 Trends Driving The Future of Healthcare Real Estate in 2020 & Beyond
Covid-19 has presented the possibility of reinventing healthcare delivery and reimbursement must support this
While there are encouraging signs of reimbursement falling in step with the move towards a more value-based healthcare system, what is needed now to further encourage healthcare innovators is to properly rationalize approval processes imposed by the FDA and CMS.
After Nebraskans cast their vote for Medicaid expansion in 2018, the state is finally expanding coverage to more residents. As part of the state’s rollout, it split its expanded Medicaid plans into two tiers, with work and other requirements to access dental and vision coverage.
As home health and home care operators move toward the ninth month of the COVID-19 pandemic, it’s important to take stock of what has been accomplished from a policy perspective. Many of 2020’s regulatory changes will be fleeting, but others will shape the future of… Read More »NAHC Pushing for Palliative Care, SNF-at-Home Medicare Benefits
Medicare doesn’t currently cover drugs approved under emergency use designations. But CMS Administrator Seema Verma said the agency was coming up with a plan to make sure Medicare beneficiaries were covered once a coronavirus vaccine is developed.
The Center for Medicare & Medicaid Innovation (CMMI) is in need of a “course correction,” top U.S. health care officials believe. And part of that may include a national expansion of the Home Health Value-Based Purchasing Model. Created under the Affordable Care Act, CMMI —… Read More »Home Health Value-Based Purchasing Model Set for Nationwide Expansion in ‘Next Year or So’
Healthcare providers won’t have to start paying back Medicare advance loans until a year after they were issued. Under the original timeline, hospitals were supposed to start paying back the loans in August.
Now that the dust has settled on the Patient-Driven Groupings Model (PDGM), some have returned their attention toward the idea of another major reimbursement overhaul: a unified post-acute payment system. There had been mounting momentum behind a unified payment model for post-acute care providers headed… Read More »Payment Reform, COVID-19 May Derail a Unified Post-Acute Care Payment System
Humana, Fresenius Medical Care Expand Partnership to Improve Care Coordination for Medicare Advantage Members
What You Should Know: – Humana Inc. and Fresenius Medical Care North America (FMCNA) today announced an agreement to broaden their collaboration toward improving the health of eligible Humana Medicare Advantage members – The agreement between Humana and Fresenius Medical Care North America goes into… Read More »Humana, Fresenius Medical Care Expand Partnership to Improve Care Coordination for Medicare Advantage Members
What You Should Know: – Innovaccer unveils new risk adjustment solution to help providers better segment their population to refine the risk scoring process and improve coding accuracy and efficiency, thereby improving performance on risk-based contracts. – The solution utilizes Artificial Intelligence (AI) and Natural… Read More »Innovaccer Unveils Risk Adjustment Solution For Improved Coding Accuracy
Roland Therriault, President, InSync Healthcare Solutions Since COVID-19 emerged as a major health threat, virtual care has taken off. As many as 46% of patients reported in late April that they had used telehealth to replace a canceled healthcare visit in 2020, while 48% of… Read More »Getting Beyond the Telehealth ‘Stop-Gap’ Mentality
In passing a bipartisan funding bill last week to avoid a possible government shutdown, the U.S. Senate officially restructured and relaxed repayment terms for the Medicare loans taken out by home health providers in spring. President Donald Trump signed the funding bill into law on… Read More »Trump Signs Funding Bill Restructuring Medicare Loan Repayment Terms
Ruby Raley, VP of Healthcare and Life Sciences at Axway Twenty years ago, technology consultants started advising CIOs to build less. That’s when the movement towards Commercial Off the Shelf (COTS) began. Today, there are many shops, especially those in small and medium-sized organizations, with… Read More »How Low-Code Solutions Reduce Headaches for Healthcare CIOs
In August, the Partnership for Quality Home Healthcare (PQHH) unveiled a first-of-its kind, comprehensive analysis of the Patient-Driven Groupings Model (PDGM). Among its findings, the analysis — conducted by health economics and policy consulting firm Dobson DaVanzo & Associates — highlighted how government spending on… Read More »Congressman Vern Buchanan Urges CMS to Scrap PDGM’s 4.36% Behavioral Adjustment
Andy Aroditis, CEO, NextGate The COVID-19 pandemic is not just a medical crisis. Since the highly contagious disease hit American shores in early 2020, the virus has dramatically changed all sectors of society, negatively impacting everything from food supply chains and sporting events to the… Read More »Accounting for the Social Determinants of Health During the COVID-19 Pandemic
New rules by the Center for Medicare and Medicaid Services would penalize hospitals and laboratories that report Covid-19 data. Hospitals would be required to report the number of confirmed or suspected Covid-19 patient, occupied beds, and availability of ventilators and other critical supplies.
Confessions of a Home Health Agency Owner: ‘CMS Is Trying to Put Agencies Like Mine Out of Business’
For decades, home health agencies have learned to operate — and often thrive — in the midst of massive change. But since the start of 2019, that change has felt overwhelming for some agency owners, particularly those who run mom-and-pop businesses with razor-thin margins. Above… Read More »Confessions of a Home Health Agency Owner: ‘CMS Is Trying to Put Agencies Like Mine Out of Business’
In order for home health providers to see reimbursement success, they need to be able to separate myths from facts when it comes to the Patient-Driven Groupings Model (PDGM). But one specific point of confusion has been primary diagnosis clinical groups. “There are a lot… Read More »Debunking Common PDGM Primary Diagnosis Myths
The U.S. Centers for Medicare & Medicaid Services (CMS) officially closed its public comment window for the 2021 proposed home health payment rule on Monday. Unlike the past couple of years, the latest proposed payment rule included relatively minor changes and rate adjustments for the… Read More »More Than Half of All Home Health Agencies Have Treated COVID-19 Patients
U.S. Senator Kirsten Gillibrand (D-NY) is asking the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) to ensure that in-home care providers have access to essential resources amid the coronavirus. Throughout the public health emergency, home health… Read More »Senator Kirsten Gillibrand Pushes for Increased PPE, Telehealth Payment for In-Home Care Providers
The U.S. Centers for Medicare & Medicaid Services (CMS) announced Friday it will not resume a full-blown resumption of the Review Choice Demonstration (RCD) for home health agencies in participating states later this month. Instead, CMS is “phasing in” RCD for agencies in North Carolina… Read More »CMS Announces New ‘Phased-In Approach’ to the Review Choice Demonstration
In designing the Patient-Driven Groupings Model (PDGM), officials from the U.S. Centers for Medicare & Medicaid Services (CMS) made a handful of assumptions about how Medicare-certified home health operators would respond once the overhaul went live. Among those assumptions, CMS believed home health agencies would… Read More »Home Health Agencies Aren’t ‘Upcoding’ to Maximize PDGM Reimbursement
The Centers for Medicare and Medicaid Services issued fines to more than 3,400 nursing homes either for infection control noncompliance or for failing to report Covid-19 data.
We need to keep in mind three key elements to successfully implement the final interoperability rules from CMS that require private payers to provide longitudinal claims data to members as well as the use of open APIs so a range of third-party applications can be… Read More »How payers and providers can address the CMS interoperability mandate
OIG: Medicare Overpaid $267M for Hospital In-Patient Claims with Post-Acute Transfers to Home Health Services
Hospitals improperly coding for post-discharge services contribute to hundreds of millions of dollars in Medicare overpayments. And the majority of incorrect payments are often related to home health services. That’s according to a new audit report from the Department of Health and Human Services (HHS)… Read More »OIG: Medicare Overpaid $267M for Hospital In-Patient Claims with Post-Acute Transfers to Home Health Services
Irv Lichtenwald, President & CEO of Medsphere Systems Corporation In the late 1940s, the United Kingdom was busily reassembling country and what remained of the empire in the aftermath of World War II. Among many revelations, the war had convinced Britain’s leaders of the need… Read More »COVID-19 Underscores Why Certain Aspects of the American Healthcare System Should Change Forever
Several federal agencies, including the Centers for Medicare and Medicaid Services, have indicated their interest in expanding telehealth coverage after the federal emergency period ends. But to do that, they’ll need the help of states and Congress.
The executive order would call on the Department of Health and Human Services to develop a new pilot payment model for rural hospitals, and would set up a task force to improve broadband infrastructure in rural communities.
Budgeting for the Future: Kindred at Home, Johns Hopkins Home Care and Always Best Care Look Ahead to 2022
As home health leaders look to the future, the lessons learned from the COVID-19 emergency will likely continue to shape their efforts for years to come. In terms of business planning, it will likely be a long while before there’s a return to a world… Read More »Budgeting for the Future: Kindred at Home, Johns Hopkins Home Care and Always Best Care Look Ahead to 2022
What You Should Know: – W2O announced today the acquisition of Discern Health, a leading healthcare consultancy based in Washington, DC, and Baltimore, to strengthen its strategic capabilities in assisting clients with critical healthcare policy trends and value-based reimbursement models. – Discern Health brings experts with… Read More »W2O Acquires Discern Health to Strengthen Value-Based Care Capabilities
Reversing a three-year decline, the number of people covered by Medicaid nationwide rose markedly this spring as the impact of the recession caused by the outbreak of COVID-19 began to take hold. Yet, the growth in participation in the state-federal health insurance program for low-income… Read More »The COVID-19 Downturn Triggers Jump in Medicaid Enrollment
Federal watchdogs are once again setting their sights on perceived improper billing practices by home health agencies. In an audit report published last week, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) found that stronger oversight of Low Utilization… Read More »OIG: CMS Could Have Saved $192M with Stronger LUPA Oversight
What You Should Know: – Sharecare acquires WhiteHatAI to provide health plan and provider clients with additional capabilities to ensure healthcare payment integrity – WhiteHatAI’s ability to detect erroneous claims before they are paid will help Sharecare’s health plan partners reduce costs associated with FWA.… Read More »Sharecare Acquires WhiteHatAI to Enhance Healthcare Payment Integrity
‘An Absolute Travesty’: Home Health Advocates Make Last-Ditch Effort to Delay Review Choice Demonstration
When the U.S. Centers for Medicare & Medicaid Services (CMS) announced that the Review Choice Demonstration (RCD) would resume for participating states in August, home-based care providers and advocates were up in arms over the decision. But as the resumption date approaches, industry advocates are… Read More »‘An Absolute Travesty’: Home Health Advocates Make Last-Ditch Effort to Delay Review Choice Demonstration
Jay Desai, CEO & Co-Founder, PatientPing As COVID-19 continues to impact the country, providers across the continuum face new challenges delivering care and ensuring safety for their patients and themselves. During this period, sharing real-time information about patients’ care encounters across provider types and care… Read More »How ADT-Based E-Notifications Can Enable Better Safety for COVID-19 Patients
As hospitals continue to experience overcapacity challenges due to the COVID-19 emergency, 911 ambulance crews and community paramedics have found themselves treating more patients at home. Historically, ambulance crews and community paramedics — both of which operate in the emergency medical services (EMS) space —… Read More »Ambulance Crews and In-Home Care Providers Seek Collaboration — Not Competition
The Centers for Medicare & Medicaid Services (CMS) was a little bit off with some of its predictions related to the Patient-Driven Groupings Model (PDGM). At least, that’s true when it comes to the first four months of 2020, according to Strategic Healthcare Programs (SHP)… Read More »PDGM Data Shows Reality-Versus-Expectations Mismatch for Case-Mix Components
The number of Medicare-certified home health agencies in the United States is dwindling — and it’s a trend that started long before the Patient-Driven Groupings Model (PDGM) kicked in. From 2018 to 2019, the number of home health agencies dropped by about 3.6%, a decrease… Read More »The Number of Medicare-Certified Home Health Agencies Is Dwindling
A bill introduced to the U.S. House of Representatives on Thursday would permanently lift site restrictions for Medicare patients to access telehealth. During the pandemic, several restrictions on where telehealth visits could be conducted and what services were eligible were temporarily lifted.
The U.S. Centers for Medicare & Medicare Services (CMS) announced Tuesday that the Review Choice Demonstration (RCD) would be renewed for participating states beginning in August. The RCD was suspended in late March due to the COVID-19 crisis, but now CMS is planning on moving… Read More »‘I’m Not Sure Their Timing Could Be Any Worse’: CMS to Resume Review Choice Demonstration
Despite the resurgence of the coronavirus in the U.S., home health providers might not have to worry about another sudden drop in admissions. When the coronavirus first began its rapid spread across the country, jumping from a long-term care facility in Washington to the New… Read More »Despite COVID-19 Resurgence, Home Health Agencies Likely to Avoid Another Sudden Admissions Drop
What You Should Know – Doctor On Demand raises $75M in Series D funding led by General Atlantic to expand comprehensive virtual care. – Doctor On Demand is seeing record usage this year – up 139% – for COVID-19 screenings, routine health issues, chronic conditions and behavioral health. San Francisco, CA-based Doctor… Read More »Doctor On Demand Raises $75M to Expand Comprehensive Virtual Care Platform
Christopher Thompson, RN, Director of Patient Experience, CenTrak Healthcare facilities and their sprawling campuses can be overwhelming and challenging to navigate. In fact, facilities lose close to $800 million a year due to missed hospital appointments, and many physicians blame a significant portion of this… Read More »Hospital Wayfinding: The Next Frontier in Healthcare Design
A proposed rule by the Centers for Medicare and Medicaid Services would expand payments for new dialysis machines when used at-home.
It’s time for policymakers, hospitals and everyone else at the health care roulette table to bet all their chips on proactive, pre-acute home-based care. During the coronavirus pandemic, the U.S. health care system has undergone a massive change marked by the skyrocketing use of telehealth… Read More »Time for Policymakers, Hospitals to Bet Big on Home-Based Care