CMS

CMS proposes fining hospitals up to $2M annually for not following price transparency rule

CMS’ latest proposed rule, which includes stringent penalties for hospitals that are found to be flouting the price transparency rule, comes on the heels of an analysis showing that a vast majority of hospitals are not in compliance with the regulation that went into effect on Jan. 1.

Transforming rural healthcare will require a funding overhaul. Here’s one way to do it.

The answer to rural healthcare’s financial issues could lie in a payment model that pools funds from public and private insurers alike to pay for agreed-upon core services, allowing rural hospitals to provide the care most needed by the communities they serve.

CMS proposes to cover mental health virtual visits through 2022

In the 1,747-page rule, which will be finalized later this year, CMS proposes expanding access to telehealth for behavioral healthcare, including for the first time allowing Medicare to pay for mental health virtual visits when they are provided by rural health clinics and federally qualified health centers and letting providers offer audio-only telehealth visits for …

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Crisis in Direct Care ‘Will Explode’ Without Immediate Government Support, PHI Warns

From low wages to a lack of career advancement opportunities, there are a number of issues that plague the caregiver workforce. Under the current presidential administration, however, there’s a chance to reexamine the state of the caregiver workforce and implement several changes that could improve the profession, thus ensuring care for seniors. PHI, a New …

Crisis in Direct Care ‘Will Explode’ Without Immediate Government Support, PHI Warns Read More »

ConcertoCare Adds Chief People Officer; CMS Appoints Medicaid Director

ConcertoCare appoints chief people officer ConcertoCare has hired Rachel Grace as its chief people officer. Backed by Deerfield Management Company, the Aliso Viejo, California-based ConcertoCare offers in-home primary care, virtual care and PACE services to dual-eligible seniors and those enrolled under Medicare Advantage. In her new role, Grace will be responsible for developing hiring and …

ConcertoCare Adds Chief People Officer; CMS Appoints Medicaid Director Read More »

XFIN Acquires Radiology Revenue Cycle Provider CMS – Health M&A

What You Should Know: – Health IT company XIFIN announced the acquisition of Computerized Management Services (CMS), a provider of comprehensive revenue management services for hospital-based radiology groups and imaging centers. CMS provides a comprehensive suite of outsourced financial services focused on maximizing radiology client revenue and cash flow streams. Its services leverage strong technology systems and analytics, including revenue cycle, strategic consulting, credentialing and coding.  – This …

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Job losses, federal regulations drove Medicaid enrollment to a historic high

Enrollment in Medicaid and the Children’s Health Insurance Program has reached a record high, with 80 million now covered through these programs. The spike was largely driven by the economic downturn brought on by the pandemic and a federal requirement that prevents states from removing people from the programs until the public health crisis is …

Job losses, federal regulations drove Medicaid enrollment to a historic high Read More »

‘Extensive’ Proposed Rule Sets Stage for Value-Based Purchasing, PDGM Adjustments

The U.S. Centers for Medicare & Medicaid Services (CMS) released its FY 2020 home health proposed payment rule on Monday, while simultaneously announcing plans for the nationwide expansion of the industry’s value-based purchasing demo. While just a few days have gone by, home health stakeholders have already started to zero-in on several key areas — …

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CMS Taking ‘Laissez-Faire’ Approach to Direct Contracting

Signify Health’s (NYSE: SGFY) leaders are as cautiously optimistic and encouraged by the prospects of direct-contracting models as almost anyone. For now, Signify works with the government to give the Centers for Medicare & Medicaid Services (CMS) insight on how the models could work in the future. The company also works with adjacent organizations that …

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CMS proposed rule aims to boost ACA enrollment, reinstate navigator duties

A new CMS proposed rule aims to make significant changes to Affordable Care Act marketplaces, including increasing the annual open enrollment period by a month and restoring the duties of navigators who help consumers from underserved populations enroll in plans on the federally facilitated exchange.

MedPAC: CMMI Should Consider a ‘Smaller, More Harmonized’ Portfolio of Alternative Payment Models

To reduce redundancies and confusion in the Medicare system, health care policymakers should consider implementing “a smaller, more harmonized” portfolio of alternative payment models (APMs). That’s according to the Medicare Payment Advisory Commission (MedPAC), which released its regular June report to Congress on Tuesday. “In many cases, providers participate in multiple [alternative payment models] simultaneously, …

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How the Medicare Advantage Landscape Has Evolved for Home Care Providers

The Medicare Advantage (MA) opportunity isn’t one that has happened overnight for home care providers, with some industry insiders even describing it as a “slow burn.” In more recent years, a shift has begun to take place, however. Although MA has become a bigger piece of the overall Medicare program puzzle, home care only stepped …

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HHS Issues New Reporting Requirements, Deadlines for Provider Relief Fund Recipients

Home health providers may have some additional financial aid in the not-too-distant future, as the federal government reportedly inches closer toward disbursing another round of CARES Act funds. As they wait for details, home health providers and other Medicare-reimbursed organizations on Friday received new reporting requirements and deadlines for the COVID-19 relief dollars they received …

HHS Issues New Reporting Requirements, Deadlines for Provider Relief Fund Recipients Read More »

KHN’s ‘What the Health?’: Our 200th Episode!

Can’t see the audio player? Click here to listen on SoundCloud. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts. The Food and Drug Administration found itself in the hot seat this week when it approved a controversial new drug to treat Alzheimer’s disease with scant evidence …

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Clover Health Announces In-Home Primary Care Expansion, Becomes New Target for Reddit Traders

Clover Health (Nasdaq: CLOV) announced Wednesday that it plans to scale its in-home primary care program, “Clover Home Care,” through the new direct-contracting model from the U.S. Centers for Medicare & Medicaid Services (CMS). The announcement came as Reddit’s investor community also targeted the health care company as its most recent cause. Headquartered in Nashville, …

Clover Health Announces In-Home Primary Care Expansion, Becomes New Target for Reddit Traders Read More »

To Better Protect Homebound Seniors, CMS Boosts Medicare Rates for At-Home COVID-19 Vaccinations

Since COVID-19 vaccines became more widely available in the U.S., home health providers have been working to “get shots in the arms” of vulnerable, homebound populations. The U.S. Centers for Medicare & Medicaid Services (CMS) announced new support for those providers on Wednesday. As part of the Biden administration’s commitment to increasing access to vaccinations, …

To Better Protect Homebound Seniors, CMS Boosts Medicare Rates for At-Home COVID-19 Vaccinations Read More »

CMS ups Medicare payment for at-home vaccinations to about $75 per dose

CMS is increasing the payment for administering at-home Covid-19 vaccinations from around $40 to $75 per dose. The move comes amid the Biden administration’s push to boost vaccinations nationwide, including among older adults who may not be able to access vaccine sites.

ONC: Rural, critical access, independent hospitals trail behind in providing health data via apps

The number of hospitals providing patients electronic access to their health information via apps has increased exponentially over the past decade. But small, rural, critical access and independent hospitals were still falling significantly behind their counterparts as of 2019, a new ONC report shows.

Report: Which US markets are ripe for ‘payvider’ models? 

“Payvider” models — that is, collaborative arrangements between payers and providers — are growing in popularity. But not all markets are created equal with regard to payvider adoption and growth. In a new report, consultancy firm Guidehouse identifies the markets with the most opportunities for payviders.

Expanding Insurance Coverage Is Top Priority for New Medicare-Medicaid Chief

The new head of the federal agency that oversees health benefits for nearly 150 million Americans and $1 trillion in federal spending said in one of her first interviews that her top priorities will be broadening insurance coverage and ensuring health equity. Use Our Content It can be republished for free. “We’ve seen through the …

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As CMS Delays CHART, Rural Providers Need to Take Value-Based Care into Their Own Hands

Lynn Barr, MPH, Founder & Executive Chair of Caravan Health The answer to solving a healthcare crisis that exacerbates barriers to care among some of the most vulnerable patient populations in the country is staring us in the face. For rural hospitals straining under the weight of erratic patient volumes, sicker populations and lack of …

As CMS Delays CHART, Rural Providers Need to Take Value-Based Care into Their Own Hands Read More »

KHN’s ‘What the Health?’: The Return of the Public Option

Can’t see the audio player? Click here to listen on SoundCloud. You can also listen on on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts. The “public option” is back — both in Washington, D.C., and the states. President Joe Biden as a candidate supported the idea of a government-run or heavily regulated insurance …

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Senate Narrowly Confirms Chiquita Brooks-LaSure as Next CMS Administrator

The U.S. Senate on Tuesday confirmed Chiquita Brooks-LaSure as next administrator of the Centers for Medicare & Medicaid Services (CMS). The agency had been without an official leader since former CMS head Seema Verma stepped down in January. The nomination was approved by a narrow 55-44 margin, with just four Republicans voting to confirm. Those …

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CMS’ rule granting speedy coverage to FDA-designated ‘breakthrough’ devices delayed again

CMS delayed the start date of its rule that would provide expedited Medicare coverage for products the FDA deems “breakthrough devices” from May 15 to Dec. 15. CMS wants more time to examine concerns expressed about the rule, including that devices may gain coverage despite limited evidence of their use among seniors.

Clover halves membership projections for direct contracting

When it planned to go public through a SPAC merger, insurance startup Clover Health told investors that it already had 200,000 direct contracting lives under contract for 2021. But in new guidance shared on Monday, the company now plans to end the year just 70,000 to 100,000 covered lives from direct contracting. 

HHS Releases New Guidance on American Rescue Plan Funding for Medicaid HCBS

When President Joe Biden signed the American Rescue Plan in March, he locked in an important payment bump for Medicaid home- and community-based services (HCBS). Among its many provisions, the $1.9 trillion legislative package raises the Federal Medical Assistance Percentages (FMAP) for certain Medicaid HCBS by 10% from April 1 of 2021 through March 31 …

HHS Releases New Guidance on American Rescue Plan Funding for Medicaid HCBS Read More »

KHN’s ‘What the Health?’: Drug Price Effort Hits a Snag

Can’t see the audio player? Click here to listen on SoundCloud. The high cost of prescription drugs is a top health issue for the public and politicians, but concerns raised by a group of moderate Democrats threaten to derail a bill being pushed by House Democratic leaders. Meanwhile, the Food and Drug Administration has authorized the …

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Signify Hopes to Expand Network Through Direct Contracting, Bundled Payments

Signify Health’s (NYSE: SGFY) home- and community-services segment continues to drive growth for the company, which went public with an over $7 billion valuation in February. Signify is not a home-based care entity in a traditional sense, but its success in the home is a reflection of the larger trends sweeping the health care sector. …

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Humana Set Up to Be Largest Home-Based Care Provider Approved for Direct Contracting

Once its 100% acquisition of Kindred at Home is finalized, Humana Inc. (NYSE: HUM) believes it will become one of the premier home health care providers in the entire country. It certainly has the resources to be just that. That’s partly because the payer-provider hybrid is also directly contracting with traditional Medicare through the Global …

Humana Set Up to Be Largest Home-Based Care Provider Approved for Direct Contracting Read More »

‘A Unique Opportunity for Home Health Providers’: CMS Extends CJR Model

The U.S. Centers for Medicare & Medicaid Services (CMS) has extended the Comprehensive Care for Joint Replacement (CJR) payment model. That’s welcome news for home health operators, as CJR has been a key program for participating agencies since its implementation. Introduced in 2016, CJR essentially allows CMS to hand out bonuses or inflict payment penalties …

‘A Unique Opportunity for Home Health Providers’: CMS Extends CJR Model Read More »

CMS finalizes new rules for ACA exchanges in 2022: 5 key provisions

CMS has adopted several new rules that will change how the Affordable Care Act exchanges operate next year. These include rules that will lower out-of-pocket consumer spending by $400 and widen eligibility for gaining health coverage outside of the designated ACA open enrollment period.

Direct-Contracting Entities Figuring Out How to Capitalize on Competitive Advantage

A delay in the Global and Professional Direct Contracting Model by the Biden administration has put the already-accepted direct-contracting entities (DCEs) in a coveted position. New entrants are no longer being accepted for participation in the model while the Centers for Medicare & Medicaid Services (CMS) and its innovation arm review the details. That gives …

Direct-Contracting Entities Figuring Out How to Capitalize on Competitive Advantage Read More »

CMS Medicare Provider Enrollment Requirements Could Drive Home Health Agencies Out of Business

Changes to the requirements for Medicare provider enrollment could have major consequences for home health providers down the line. Under provider enrollment requirements, the U.S. Centers for Medicare & Medicaid Services (CMS) has the authority to rescind providers’ Medicare enrollment if they are associated with “bad actors” and are at risk for fraud due to …

CMS Medicare Provider Enrollment Requirements Could Drive Home Health Agencies Out of Business Read More »

CMS proposes putting $2.5B into hospitals’ coffers, eliminating part of price transparency rule

CMS has released its proposed inpatient payment rule for fiscal year 2022, which includes a payment bump that could increase reimbursement for hospitals by $2.5 billion. Further, in a win for hospitals, the proposal aims to repeal a part of the price transparency rule related to Medicare Advantage plans.

KHN’s ‘What the Health?’: Picking Up the Pace of Undoing Trump Policies

Can’t see the audio player? Click here to listen on SoundCloud. The Biden administration is speeding up the pace of efforts to undo Trump administration health policies. The two most recent: overturning a ban on fetal tissue research funded by the National Institutes of Health and canceling a last-minute extension of a Medicaid waiver for Texas. …

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Confirmation Delay for Next CMS Administrator Could Cause Problems for Home-Based Care Providers

It has been over three months since former Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma resigned from her post. As of Wednesday, no one has officially filled the position’s void. The Biden administration’s pick for administrator, Chiquita Brooks-LaSure, has yet to be confirmed by the Senate due to ongoing partisan disputes. For …

Confirmation Delay for Next CMS Administrator Could Cause Problems for Home-Based Care Providers Read More »

Pause to Alternative Payment Models Gives Some Providers a ‘Golden Ticket,’ Leaves Others Behind

The Global and Professional Direct Contracting Model — a Center for Medicare & Medicaid Innovation (CMMI) creation — has been put on pause. The holdup is just another example of CMMI pumping the brakes on an alternative payment model in the days since the new Biden administration took over the executive branch. Broadly, the Global …

Pause to Alternative Payment Models Gives Some Providers a ‘Golden Ticket,’ Leaves Others Behind Read More »

New CMMI Director Liz Fowler: US at ‘Really Critical Juncture’ on Path to Value-Based Care

The U.S. health care system has hit a defining moment in its shift toward value-based care, with the major decision in 2021 being an aggressive acceleration or cautious slowdown of the nation’s portfolio of alternative payment models. Liz Fowler, the new head of the Center for Medicare and Medicaid Innovation (CMMI), has been thinking about …

New CMMI Director Liz Fowler: US at ‘Really Critical Juncture’ on Path to Value-Based Care Read More »

How CMS final rule will impact E/M coding and documentation requirements

Historically, providers had to meet certain criteria and address three key areas in the patient’s progress notes: patient history, physical exam and medical decision making. CMS has eliminated the history and exam components as required elements for billing purposes, so medical decision making is now the sole driver of the level-of-service.

Boost Operational, Clinical and Financial Performance with Good Data

Peter Nelson, VP & General Manager, Global Alliances at GHX There’s an old adage that every challenge is merely an opportunity in disguise. COVID-19 highlighted the healthcare industry’s ongoing challenge with producing clean, standardized data. As the industry looks to rebound from the severe financial impact of the pandemic, there’s a renewed urgency among hospitals …

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Indiana’s Medicaid Expansion — Designed by Pence and Verma — Panned in Federal Report

Indiana’s Medicaid expansion — with its “personal responsibility” provisions that require enrollees to pay monthly premiums and manage health savings accounts — proved no better at improving health and access to care than other state expansions, a federally commissioned study found. Use Our Content It can be republished for free. Even when compared with states …

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What Home Health Providers Need to Know About Medicare Loan Recoupment

It has been six months since the U.S. Centers for Medicare & Medicaid Services (CMS) gave home health agencies and other Medicare providers a reprieve from having to pay back advance and accelerated payment loans. But recoupment for these loans is just around the corner. To avoid future financial headaches, providers must be prepared to …

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Hospital-at-Home Holdouts: Why In-Home Acute Care Isn’t for the Faint of Heart

After making gradual inroads over the past few years, the hospital-at-home model has seemingly had its breakthrough moment. That came in November, when the U.S. Centers for Medicare & Medicaid Services (CMS) introduced its “Acute Hospital Care At Home” wavier program. The creation of CMS’s wavier — a COVID-19 relief measure — has created a …

Hospital-at-Home Holdouts: Why In-Home Acute Care Isn’t for the Faint of Heart Read More »

How the Pandemic is Accelerating the Shift to Alternative Care Delivery Models

Mark Prather MD, MBA, CEO & Co-founder at DispatchHealth The COVID-19 pandemic has transformed how we interact with one another, with businesses, and with the world around us. From social distancing to hand sanitation to remote working, its impact on society is immense. And among the various industries that are experiencing significant change as a …

How the Pandemic is Accelerating the Shift to Alternative Care Delivery Models Read More »

Under New Cost-Cutting Medicare Rule, Same Surgery, Same Place, Different Bill

A cost-saving change in Medicare launched in the final days of the Trump administration will cut payments to hospitals for some surgical procedures while potentially raising costs and confusion for patients. This story also ran on The Washington Post. It can be republished for free. For years, the Centers for Medicare & Medicaid Services classified …

Under New Cost-Cutting Medicare Rule, Same Surgery, Same Place, Different Bill Read More »

With Time Running Out, House Passes Medicare Sequestration Bill

Home health providers are one step closer to getting a continued suspension of Medicare sequestration payment reductions. The U.S. House of Representatives passed H.R. 1868 by a 246-175 vote on Friday. The bill, originally introduced earlier this month by House Majority Leader Steny Hoyer (D-Md.), pauses automatic spending cuts to Medicare and other programs for …

With Time Running Out, House Passes Medicare Sequestration Bill Read More »

CMS Increases Vaccine Reimbursement for Home Health Providers, Others

The U.S. Centers for Medicare & Medicaid Services (CMS) announced Monday that it is increasing the Medicare payment amount for administering the COVID-19 vaccine. That could lift the home health organizations that have been able to play a role in vaccinating homebound seniors throughout their communities. Not all in-home care operators have been able to …

CMS Increases Vaccine Reimbursement for Home Health Providers, Others Read More »

OIG Sets Guidelines for Hospitals Referring to Home Health Providers

Federal regulators have thrown weight behind ensuring that patients have a more active role in their care transitions. The Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) recently drafted compliance guidance for hospitals on the topic. Under the guidance, OIG requires hospitals to share a list of …

OIG Sets Guidelines for Hospitals Referring to Home Health Providers Read More »

Waystar Launches Price Transparency Solutions to Meet Consumer Demand

What You Should Know:  – Waystar, a provider of healthcare payments software, today announced the addition of the Text Statements feature to its suite of payment tools. This new solution enables patients to easily view and pay medical bills directly from their smartphone, bringing transparency and convenience to the patient financial experience – a long-standing …

Waystar Launches Price Transparency Solutions to Meet Consumer Demand Read More »

Providers, tech companies to advocate for expanding clinical care at home

A group of healthcare stakeholders — Amazon Care, Intermountain Healthcare and Ascension, to name a few — has created an alliance to advocate for home-based care services through policy changes.

Payers Struggle with Provider Data Management Too

Eric Demers, CEO of Madaket Health Provider data management is usually discussed from the provider perspective: the busy staff, the needless paperwork amid a pandemic, the faxing, emailing and uploading of data. In these scenarios, the health plans are often painted as the villains for their bureaucratic processes and unique requirements. But the reality is …

Payers Struggle with Provider Data Management Too Read More »

Medicare Cuts Payment to 774 Hospitals Over Patient Complications

Use Our Content It can be republished for free. The federal government has penalized 774 hospitals for having the highest rates of patient infections or other potentially avoidable medical complications. Those hospitals, which include some of the nation’s marquee medical centers, will lose 1% of their Medicare payments over 12 months. The penalties, based on …

Medicare Cuts Payment to 774 Hospitals Over Patient Complications Read More »

Home Health Experts Offer Update on Transition to No-Pay RAPs

It’s been 48 days since the start of “no-pay RAPs” in home health care. During this time, providers have had to navigate a sea of challenges and unexpected speed bumps while adjusting to the new process. The U.S. Centers for Medicare & Medicaid Services (CMS) kicked off no-pay RAPs on Jan. 1 of this year. …

Home Health Experts Offer Update on Transition to No-Pay RAPs Read More »

Home Health Value-Based Purchasing Model Could Limit Access to Care, Critics Caution

In January, the U.S. Department of Health and Human Services (HHS) revealed plans to expand the Home Health Value-Based Purchasing (HHVBP) Model — a Medicare demonstration that aims to tie reimbursement to quality of care. While HHVBP has gained popularity within the home health industry, some experts believe there are potential downsides to scaling the …

Home Health Value-Based Purchasing Model Could Limit Access to Care, Critics Caution Read More »

Health Plans Must Go Beyond the ONC Mandate and Prioritize Member Experience

Minal Patel, CEO of Abacus Insights Laurent Rotival, SVP, Strategic Technology Solutions & CIO, Cambia Solutions We are all frustrated when there’s a glitch with our online banking, or if bandwidth problems interfere with streaming the movie we want to watch. Imagine how individuals will react when the results of a cancer screening don’t find …

Health Plans Must Go Beyond the ONC Mandate and Prioritize Member Experience Read More »

What providers need to know about OIG’s plans to audit telehealth services

The Office of the Inspector General will audit Medicare Part B telehealth services to detect potential vulnerabilities and ensure compliance with regulatory requirements. To prepare, providers must first take stock of their programs and conduct audits of their own, experts say.

Why hospitals want CMS, FTC to examine two UnitedHealthcare policies

Two UnitedHealthcare policies have raised several concerns among providers, including that they may display anti-competitive behavior and could block patient access to certain healthcare services. The American Hospital Association is asking the FTC and CMS to review and potentially block these policies.

As Becerra Awaits HHS Confirmation, Biden Reportedly Narrows Picks to Head CMS

There’s a new name being circulated for President Joe Biden’s top pick to lead the U.S. Centers for Medicare & Medicaid Services (CMS). Chiquita Brooks-LaSure — a former policy official who played a key role in guiding the Affordable Care Act through passage and implementation — is now the likeliest candidate to run CMS, according …

As Becerra Awaits HHS Confirmation, Biden Reportedly Narrows Picks to Head CMS Read More »

COVID-19 Funding Presents an ‘Enforcement Perfect Storm’ for Home Health Providers, Others

The federal government saw $2.2 billion in civil fraud recoveries in 2020. Roughly 82% of those settlements and judgments — about $1.8 billion — were from matters related to the health care sector. That’s according to a recent report from Nashville, Tennessee-based law firm Bass, Berry & Sims. The report examined significant health care fraud …

COVID-19 Funding Presents an ‘Enforcement Perfect Storm’ for Home Health Providers, Others Read More »

KHN’s ‘What the Health?’: The Long Road to Unwinding Trump Health Policies

Can’t see the audio player? Click here to listen on SoundCloud. Thursday was “health day” in President Joe Biden’s sprint to launch his presidency, and he signed two executive orders addressing health coverage and women’s reproductive rights. The orders will reopen enrollment under the Affordable Care Act from February to May and reverse the so-called Mexico …

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A New System to Fit A New Economy: How Healthcare Can Recover From COVID-19

Paula Muto, MD, FACSFounder and CEO, UBERDOC, Inc. We are at a watershed moment. The COVID-19 pandemic has forced us to reevaluate our priorities both economically and with regard to public health. Living with a healthcare system that was created in response to an emergency measure during World War II, US consumers have struggled for …

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Why CMS Will Lead the 2021 Kidney Care Revolution

Chris Riopelle, CEO of Strive Health After an unprecedented year, kidney care providers, including nephrologists, dialysis facilities, and care extenders are expecting 2021 to follow suit. We will see an overhaul in reimbursement and major industry shifts, partly led by CMS, that will require providers to advance their capabilities in a way that will usher …

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MACs Report Processing Glitches for No-Pay RAPs

Among payment-related policy changes for the home health industry in 2021 is the elimination of traditional Requests for Anticipated Payment (RAPs) — and the introduction of the “no-pay RAP.” While the change is a potentially costly one for home health agencies, they’re not the only ones struggling to keep up. Medicare Administrative Contractors (MACs) have …

MACs Report Processing Glitches for No-Pay RAPs Read More »

Biden Administration Includes ‘Home Care Workforce Crisis’ in New Pandemic Plan

President Joe Biden focused on the ongoing COVID-19 pandemic during his first full day in office Thursday. In doing so, he once again drew attention to home-based care and getting the current “workforce crisis” under control. “Our national strategy is comprehensive,” Biden said during an address from the White House. “It’s based on science, not …

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Top Home Health Trends for 2021

“Nobody knows what the future holds” has been one of the biggest lessons learned during the COVID-19 emergency. But even as the home health industry plays its part in responding to new infection spikes across parts of the country, it has never been more important to stay ahead of the curve. To remain competitive in …

Top Home Health Trends for 2021 Read More »

Provider Strategies for Mitigating Telehealth Fraud & Abuse in 2021

Dr. Gary Call, Chief Medical Officer at HMS As healthcare spending continues to rise, so too does the inherent risk for bad actors to take advantage. Today, the United States is estimated to spend nearly 18 percent of its GDP, or $3.6 trillion, on healthcare, and is expected to increase to one-fifth of GDP within …

Provider Strategies for Mitigating Telehealth Fraud & Abuse in 2021 Read More »

New CMS rule to enable immediate coverage for FDA-designated ‘breakthrough’ devices

The agency has finalized a rule that allows it to provide immediate Medicare coverage for FDA-approved products that are deemed “breakthrough devices.” The new coverage process would enable seniors to get access to these devices more quickly, but some provider and payer groups are concerned that this could cause patient harm.

National Expansion of Home Health Value-Based Purchasing Model Estimated to Create $6.3B in Savings

In somewhat of a surprise move, U.S. health care policymakers unveiled plans last week to expand the Home Health Value-Based Purchasing (HHVBP) Model, a nine-state Medicare demonstration designed to better align reimbursement to quality of care. Despite backing from most of the home health industry, the HHVBP Model — first implemented in 2016 — had …

National Expansion of Home Health Value-Based Purchasing Model Estimated to Create $6.3B in Savings Read More »

HHS Announces Plans to Expand the Home Health Value-Based Purchasing Model

Home health providers are getting one of their biggest wishes granted. The U.S. Department of Health and Human Services (HHS) announced Friday that it is expanding the Home Health Value-Based Purchasing (HHVBP) Model. First implemented in 2016, the HHVBP Model is currently active in just nine states: Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, …

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Trump Administration Approves First Medicaid Block Grant, in Tennessee

Use Our Content It can be republished for free. With just a dozen days left in power, the Trump administration on Friday approved a radically different Medicaid financing system in Tennessee that for the first time would give the state broad authority in running the health insurance program for the poor in exchange for capping …

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Xealth’s CEO Shares Impact of Digital Health in 2020 and What’s Ahead in 2021

Mike McSherry, CEO & Co-founder of Xealth HIT Consultant sat down with Mike McSherry, CEO, and co-founder of Seattle-based digital prescription platform Xealth to discuss digital health lessons learned in 2020 and what we can expect in 2021. As Xealth’s CEO, Mike also works with Duke Health, UPMC, Atrium Health, and The Froedtert & the …

Xealth’s CEO Shares Impact of Digital Health in 2020 and What’s Ahead in 2021 Read More »

UNC Health Rolls out Hospital-at-Home Program with Medically Home

UNC Health is throwing its hat in the hospital-at-home ring. The North Carolina-based health system announced Monday that it has plans to launch an acute hospital care at home program in partnership with Medically Home. UNC Health is a state-owned integrated health care system based in Chapel Hill. The organization is made up of 12 …

UNC Health Rolls out Hospital-at-Home Program with Medically Home Read More »

CMS Approves 5 More Hospitals for Hospital-at-Home Initiative, Raising Total to 56

The U.S. Centers for Medicare & Medicaid Services (CMS) has approved a handful of new hospitals under its rapidly growing hospital-at-home initiative, Administrator Seema Verma announced on Monday. Originally unveiled at the end of November, CMS’s “Acute Hospital Care at Home” initiative is designed to give hospitals “unprecedented” and “comprehensive” regulatory flexibilities to treat certain …

CMS Approves 5 More Hospitals for Hospital-at-Home Initiative, Raising Total to 56 Read More »

12 Telehealth & Virtual Care Predictions and Trends for 2021 Roundup

Dr. Paul Hain, Chief Medical Officer of GoHealth Telehealth is Here to Stay in 2021 Prior to the pandemic, telehealth was a limited ad-hoc service with geographic and provider restrictions. However, with both the pandemic restrictions on face to face interactions and a relaxation of governmental regulations, telehealth utilization has significantly increased from thousands of …

12 Telehealth & Virtual Care Predictions and Trends for 2021 Roundup Read More »

MA Beneficiaries See Nearly 20% Fewer Home Health Days Than Traditional Medicare Peers

Under the Trump administration, federal health care policymakers have long been vocal about the ability of Medicare Advantage (MA) to lower costs and improve outcomes among vulnerable populations. A recent report from the Washington, D.C.-based Better Medicare Alliance (BMA) and consulting firm Avalere Health is now putting hard numbers on that claim, particularly around home …

MA Beneficiaries See Nearly 20% Fewer Home Health Days Than Traditional Medicare Peers Read More »

CIO: 3 Rules for Meeting ONC/CMS Interoperability, While Improving Cybersecurity

Scott Galbari, CTO, Lyniate Drew Ivan, Chief Product and Strategy Officer, Lyniate Healthcare data security has been a growing concern for CIOs for the last year or so, as hackers are increasingly targeting health information. Now, with a global pandemic forcing a shift to telemedicine and remote work, and new rules from the ONC and …

CIO: 3 Rules for Meeting ONC/CMS Interoperability, While Improving Cybersecurity Read More »

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

As we close out the year, we asked several healthcare executives to share their predictions and trends for 2021. Kimberly Powell, Vice President & General Manager, NVIDIA Healthcare Federated Learning: The clinical community will increase their use of federated learning approaches to build robust AI models across various institutions, geographies, patient demographics, and medical scanners. The sensitivity and …

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021 Read More »

5 Post-Acute Care Industry Trends to Watch in 2021

What You Should Know: – Healthcare technology company Forcura names the five most significant trends for the post-acute care industry in 2021. The post-acute care (PAC) sector saw some of its most profound challenges this year, from deadly COVID-19 outbreaks in skilled nursing facilities (SNFs) to a suddenly accelerated need for the services provided by …

5 Post-Acute Care Industry Trends to Watch in 2021 Read More »

For Better Patient Care Coordination, We Need Seamless Digital Communications

Catherine Thomas: Co-Founder and VP, Customer Engagement, careMESH  Peter Tippett MD, PhD: Founder and CEO, careMESH A recent Advisory Board briefing examined the annual Centers for Medicare & Medicaid Services (CMS) Readmission penalties.  Of the 3,080 hospitals CMS evaluated, 83% received a penalty for payments to be made in 2021, based on expected outcomes for a …

For Better Patient Care Coordination, We Need Seamless Digital Communications Read More »

Stimulus Money, Therapy Changes and COVID-19 Strategies: Top Home Health Stories of 2020

The Patient-Driven Groupings Model (PDGM) was supposed to define home health care in 2020. Instead, this year was almost entirely shaped by COVID-19, a point that’s reinforced by the most widely read stories on Home Health Care News. Of the top-10 stories on HHCN in 2020, eight were related to coronavirus coverage. From the first …

Stimulus Money, Therapy Changes and COVID-19 Strategies: Top Home Health Stories of 2020 Read More »

National Home Health Spending Reaches All-Time High of $113.5 Billion

National home health spending soared to a whopping $113.5 billion in 2019, according to a new analysis from the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary published Wednesday in the journal Health Affairs.  While that figure marked another all-time high for home health care, the U.S. government still spent far more …

National Home Health Spending Reaches All-Time High of $113.5 Billion Read More »

American Academy of Home Care Medicine Urges CMS to Reconsider Rate Cut for Home-Based Primary Care

At the beginning of the month, the Centers for Medicare & Medicaid Services (CMS) released the final rule for the 2021 Medicare Physician Fee Schedule. Since then, the rule has drawn criticism for the payment cuts CMS made to home-based primary care visits, a move that experts believe will jeopardize access to care for seniors …

American Academy of Home Care Medicine Urges CMS to Reconsider Rate Cut for Home-Based Primary Care Read More »

Landmark Health Gearing Up for Direct-Contracting Participation

In April 2019, the U.S. Centers for Medicare & Medicaid Services (CMS) rolled out a new suite of direct-contracting payment models, with the goal of accelerating the shift to value-based care. Since then, exactly 51 direct-contracting entities (DCEs) have signed up for either the ”global” or “professional” options. Among them is Huntington Beach, California-based Landmark …

Landmark Health Gearing Up for Direct-Contracting Participation Read More »

CMS proposed rule requires payers to streamline prior authorizations

The rule would require payers in the Medicaid, CHIP and QHP programs to build and maintain application programing interfaces to improve data exchange and the prior authorization process. But the rule does not include Medicare Advantage plans, which the American Hospital Association called “disappointing.”

As Telehealth Surges, Are Seniors Being Left Behind?

Anne Davis, Director of Quality Programs & Medicare Strategy at HMS A global health crisis has thrust us into a scenario in which lives quite literally depend on the ability to virtually connect. Telehealth has rapidly emerged as a vital tool, enabling continuity of care, allowing vulnerable individuals to access their physician from home, and …

As Telehealth Surges, Are Seniors Being Left Behind? Read More »

Despite COVID-19: Providers Should Not Lose Sight of MIPS Compliance

Courtney Tesvich, VP of Regulatory at Nextech When 2020 began, no one anticipated that complying with the Merit-based Incentive Payment System (MIPS)—the flagship payment model of the Centers for Medicare & Medicaid Services (CMS) Quality Payment Program (QPP)—would look so different halfway through the year. Like many other things, the COVID-19 crisis has delayed, diverted, …

Despite COVID-19: Providers Should Not Lose Sight of MIPS Compliance Read More »

CMS’ new Geo care delivery model: 5 things to know

The new Geographic Direct Contracting Model aims to improve quality of care and slash costs for Medicare beneficiaries across an entire region. It involves setting up risk-sharing arrangements where participants will be responsible for the total cost of care for beneficiaries in the region.

Pair Team Emerges Out of Stealth with $2.7M to Automate Primary Care Operations

What You Should Know: – San Francisco-based digital health startup Pair Team emerges out of stealth with $2.7M in seed funding backed by Kleiner Perkins, Craft Ventures, & YC. – Pair Team provides both a remote team and AI that automates workflows, provides infrastructure & improves medical practices — efficiencies and billing as you’d expect, …

Pair Team Emerges Out of Stealth with $2.7M to Automate Primary Care Operations Read More »

Ensuring Telehealth Providers’ Virtual Care Dollars Make Sense

Don Godbee Don Godbee, Mobile Solutions Architect at Stratix Don Godbee Telehealth and virtual care are not brand-new phenomena suddenly cobbled together as a rapid response to the onset of the COVID-19 pandemic, but the average US patient could be forgiven for thinking that it is. Indeed, virtual visits to care providers and remote patient …

Ensuring Telehealth Providers’ Virtual Care Dollars Make Sense Read More »

House Bill Looks to Keep Medicare Sequestration ‘Holiday’ in Place for Home Health Agencies, Others

U.S. Representatives Brad Schneider (D-Ill.) and David McKinley (R-W.Va.) introduced the Medicare Sequester COVID Moratorium Act last week. If passed, the bill would extend the temporary suspension of Medicare sequestration payment reductions, giving home health agencies and other providers more financial flexibility headed into an uncertain 2021. Since 2014, the U.S. Centers for Medicare & …

House Bill Looks to Keep Medicare Sequestration ‘Holiday’ in Place for Home Health Agencies, Others Read More »

5 Steps for Interoperability Excellence for Healthcare Providers

Shanti Wilson, Consultant, Freed Associates  As if 2020 couldn’t be any more challenging for healthcare providers, new federal rules on interoperability and patient access, granting patients direct access to their healthcare data, begin taking effect this November and continue into 2022. These rules, while ultimately beneficial to patients, bring an additional level of operational complexity to …

5 Steps for Interoperability Excellence for Healthcare Providers Read More »

‘An Arm and a Leg’: Obamacare Alum Andy Slavitt Takes Stock of the COVID Pandemic — So Far

Can’t see the audio player? Click here to listen. Andy Slavitt has spent much of 2020 talking with almost everybody who knows anything about the COVID-19 pandemic — and sharing what he learns in real time, first on Twitter, then on his pandemic podcast, “In the Bubble.” To do our own podcast episode about what we’ve …

‘An Arm and a Leg’: Obamacare Alum Andy Slavitt Takes Stock of the COVID Pandemic — So Far Read More »

CommonHealth App Connects to 230 Health Systems to Share Health Data – including COVID Test and Vaccine Status

What You Should Know: – CommonHealth has connected to 230 health systems in the United States, allowing patients to gather, manage and share their health and test data, including COVID test and vaccination status. By the end of this month, CommonHealth will connect to more than 340 health systems – CommonHealth extends the health data …

CommonHealth App Connects to 230 Health Systems to Share Health Data – including COVID Test and Vaccine Status Read More »

5 Myth-Busting New Hospital ADT Notification Requirements

 Claudia Williams, CEO of Manifest MedEx When doctors know their patients have been to the hospital, they can act fast to provide needed support. Widespread use of hospital event notifications is associated with all kinds of health benefits, including a 10 percent decrease in readmissions for Medicare beneficiaries. These event notifications are one of the …

5 Myth-Busting New Hospital ADT Notification Requirements Read More »

CMS Announces New Direct-Contracting Model to Promote ‘Easier Access to Home Care’

In April 2019, federal health care officials unveiled a new direct-contracting payment model to accelerate the shift toward value-based care for U.S. primary care providers. The goal of that model — which has 51 entities already signed up — was to bring a private-sector approach to risk-sharing arrangements in traditional Medicare. The U.S. Centers for …

CMS Announces New Direct-Contracting Model to Promote ‘Easier Access to Home Care’ Read More »

New CMS Hospital-at-Home Program Could Boost Business for Home Health Agencies

In its initial announcement, the U.S. Centers for Medicare & Medicaid Services (CMS) went out of its way to clearly state its new hospital-at-home waiver program was not designed for home health agencies. But that doesn’t mean there isn’t any upside for them, industry insiders say. Unveiled on Nov. 25, CMS’s new hospital-at-home waiver program …

New CMS Hospital-at-Home Program Could Boost Business for Home Health Agencies Read More »

Brigham and Women’s, Biofourmis launch hospital-at-home solution nationwide

The Boston-based hospital and digital therapeutics company are rolling out their co-developed remote monitoring solution across the country, which can help hospitals rapidly implement hospital-at-home programs. The announcement comes soon after CMS launched a program enabling health systems to provide hospital-level care at home for more than 60 conditions.

New Hospital-at-Home Waiver Program Is ‘Another Step Forward’ for Home-Based Care

The Centers for Medicare & Medicaid Services (CMS) last week took extraordinary steps toward increasing the U.S. health care system’s capacity by shifting more acute care into the home. In a Wednesday announcement, CMS unveiled new, comprehensive flexibilities that allow hospitals to provide their services “in locations beyond their existing walls.” To secure those flexibilities, …

New Hospital-at-Home Waiver Program Is ‘Another Step Forward’ for Home-Based Care Read More »

Non-Physician Certification in Home Health Care Blocked by State-Level Barriers

Over the past several years, it seems as though the home health industry has been inching closer and closer toward the elimination of Medicare’s strict physician-certification policy. Now — thanks to the CARES Act — nurse practitioners (NPs), physician assistants (PAs) and clinical nurse specialists (CNSs) are able to certify eligibility for home health. While …

Non-Physician Certification in Home Health Care Blocked by State-Level Barriers Read More »

CMS’s Stark Law Changes Could Mean More Value-Based Business for Home Health Operators

In an effort to boost value-based care, the U.S. Centers for Medicare & Medicaid Services (CMS) recently announced that it has finalized changes to the Physician Self-Referral Law — often referred to as the Stark Law. For home health providers, the changes could mean more opportunities for value-based care arrangements moving forward, experts believe. Broadly, …

CMS’s Stark Law Changes Could Mean More Value-Based Business for Home Health Operators Read More »

CMS Launches ‘Unprecedented’ Hospital-at-Home Strategy to Manage Latest COVID-19 Surge

In an effort to increase hospital capacity amid the current COVID-19 surge, the U.S. Centers for Medicare & Medicaid Services (CMS) on Wednesday announced “unprecedented” flexibilities around providing hospital-level care for patients in their homes. Similar to CMS’s recent allowances surrounding telehealth, the agency’s latest efforts are focused on lifting barriers that could potentially hinder …

CMS Launches ‘Unprecedented’ Hospital-at-Home Strategy to Manage Latest COVID-19 Surge Read More »

COVID-19: How Can Payers Prepare for Mandates and Support Pandemic Relief Efforts

Elizabeth Bierbower, Former President of Humana’s Group & Specialty Division Healthcare can achieve optimum efficiency when patients are at the center of care. When patients have the necessary information to navigate their care journey, they will choose the path to high-quality care at the lowest costs. Cost-sharing and insurance premiums are rising consistently since the …

COVID-19: How Can Payers Prepare for Mandates and Support Pandemic Relief Efforts Read More »

LHC Group CEO Keith Myers: Change in Washington Won’t Derail ‘Incredible’ Home Health Opportunity

Keith Myers has seen his fair share of change in Washington, D.C. Since co-founding the business with his wife, Ginger, in 1994, Myers has helped lead LHC Group Inc. (Nasdaq: LHCG) through parts of five presidencies as chairman and CEO. A new administration with Joe Biden in the White House would make that six. Although …

LHC Group CEO Keith Myers: Change in Washington Won’t Derail ‘Incredible’ Home Health Opportunity Read More »

An ‘Awkward Transition Year’: Why 2021 Will Look Different in Home Health with New RAP Adjustments

The U.S. Centers for Medicare & Medicaid Services (CMS) issued its final 2021 home health payment rule in late October. When it came out, some providers were less than pleased. On one hand, the Patient-Driven Groupings Model (PDGM) wasn’t substantially altered to balance out its flawed behavioral assumptions. On another, there are also a few …

An ‘Awkward Transition Year’: Why 2021 Will Look Different in Home Health with New RAP Adjustments Read More »

CMS: Home Health Improper Payments Down by $5.9B Since 2016

Home health providers continue to make serious progress in reducing improper payments under fee-for-service Medicare, the U.S. Centers for Medicare & Medicaid Services (CMS) announced Monday. Since 2016, improper payments to home health providers have dropped by an estimated $5.9 billion, according to CMS. All improper payments in fee-for-service Medicare are down by an estimated …

CMS: Home Health Improper Payments Down by $5.9B Since 2016 Read More »

How TRU Community Care Used Telehealth to Revamp Its Palliative Care Program

Despite a vital need for palliative care in community settings, home-based care providers have been slow to invest in such services. Providers have often cited financial concerns as a roadblock. Yet those providers that have turned their attention to palliative care frequently see positive returns. TRU Community Care, for example, saw its palliative care segment …

How TRU Community Care Used Telehealth to Revamp Its Palliative Care Program Read More »

8 Ways Advanced Analytics Can Help You Decide If Telehealth Should Be Temporary or Permanent

Prasad Dindigal, Vice President, Healthcare & Life Sciences, EXL. Over the past few months, primarily as a result of the COVID-19 pandemic, telehealth has gone from a “nice-to-have” to a “must-have” for healthcare providers. The surge of COVID-19 patients in the spring, coupled with “stay-at-home” orders in many states, meant that many patients in need …

8 Ways Advanced Analytics Can Help You Decide If Telehealth Should Be Temporary or Permanent Read More »

To Solve Healthcare Interoperability, We Must ‘Solve the Surround’

Peter S. Tippett, MD, Ph.D., Founder & CEO of careMesh Interoperability in healthcare is a national disgrace. After more than three decades of effort, billions of dollars in incentives and investments, State and Federal regulations, and tens of thousands of articles and studies on making all of this work — we are only slightly better …

To Solve Healthcare Interoperability, We Must ‘Solve the Surround’ Read More »

Sony Updates NUCLeUS Medical Imaging Platform to Support Remote Patient Observation

What You Should Know: – Today, Sony announced an update to our NUCLeUS medical imaging platform, which improves support for remote patient observation. – NUCLeUS has added new functionality and features, including powerful bi-directional telestration capabilities allowing multiple remote users to simultaneously annotate, draw or highlight areas of interest in a live stream video or …

Sony Updates NUCLeUS Medical Imaging Platform to Support Remote Patient Observation Read More »

Q&A with Experian Health senior director of data compliance on CMS updates for Medicare ABN forms

As every healthcare executive knows, a healthy revenue cycle relies on precise paperwork. That’s why all Medicare providers should be paying close attention to the revised medical necessity form, which will be mandatory starting January 1, 2021. Failure to use the new Advance Beneficiary Notice of Non-coverage (ABN) form could lead to denied claims, financial …

Q&A with Experian Health senior director of data compliance on CMS updates for Medicare ABN forms Read More »

Feds Approve Fractious Georgia Plan to Change ACA Marketplace

With the Trump administration announcing two days before Election Day that Georgia’s healthcare.gov website will no longer provide options for residents shopping for plans starting in 2022, consumers will need to rely on private brokers, insurance companies, agents and commercial websites. Republican Georgia Gov. Brian Kemp, who pushed the plan, argued that this would give …

Feds Approve Fractious Georgia Plan to Change ACA Marketplace Read More »

Verma: Older Adults Must Have a ‘More Robust’ Set of Home Care Options

The U.S. Centers for Medicare & Medicaid Services (CMS) on Monday touted several tools designed to help states rebalance their long-term care ecosystem toward home- and community-based services.  The development is the latest in a series of CMS efforts aimed at strengthening home- and community-based services amid the COVID-19 pandemic, with the ultimate goal of …

Verma: Older Adults Must Have a ‘More Robust’ Set of Home Care Options Read More »

Medicare Fines Half of Hospitals for Readmitting Too Many Patients

Nearly half the nation’s hospitals, many of which are still wrestling with the financial fallout of the unexpected coronavirus, will get lower payments for all Medicare patients because of their history of readmitting patients, federal records show. The penalties are the ninth annual round of the Hospital Readmissions Reduction Program created as part of the …

Medicare Fines Half of Hospitals for Readmitting Too Many Patients Read More »

Late RAPs Could Trigger Immediate 20% Payment Reduction in 2021

The U.S. Centers for Medicare & Medicaid Services (CMS) released its final home health payment rule for CY 2021 on Thursday, with essentially no changes to the Patient-Driven Groupings Model (PDGM) or its controversial behavioral adjustment.  In addition to doubling down on PDGM, boosting the home health base payment rate by 1.9% and making minor …

Late RAPs Could Trigger Immediate 20% Payment Reduction in 2021 Read More »

[Updated] CMS Finalizes 1.9% Home Health Rate Increase for 2021, Keeps PDGM’s Behavioral Adjustment

The U.S. Centers for Medicare & Medicaid Services (CMS) issued its final 2021 home health payment rule Thursday. In doing so, it changed very little from what it first proposed in June. The final rule adds an estimated $390 million home health payment boost for agencies in 2021, or an aggregate increase of 1.9%. That …

[Updated] CMS Finalizes 1.9% Home Health Rate Increase for 2021, Keeps PDGM’s Behavioral Adjustment Read More »

The Trump Medicaid Record: Big Goals, Yet Few Successes

President Donald Trump entered office seeking a massive overhaul of the Medicaid program, which had just experienced the biggest growth spurt in its 50-year history. His administration supported repealing the Affordable Care Act’s Medicaid expansion, which has added millions of adults to the federal-state health program for lower-income Americans. He also wanted states to require …

The Trump Medicaid Record: Big Goals, Yet Few Successes Read More »

HHS Loosens Provider Relief Fund Restrictions, Allows Agencies to Cover Lost Revenue

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 toward lost revenue that’s potentially unrelated to COVID-19. “After reimbursing …

HHS Loosens Provider Relief Fund Restrictions, Allows Agencies to Cover Lost Revenue Read More »

CMS Direct Contracting Model Options for Value-Based Care

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 new model is to create the next generation of risk-sharing …

CMS Direct Contracting Model Options for Value-Based Care Read More »

Rural Hospital Execs Can Beat COVID-19 By Shifting From Reactive to Proactive 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. According to CDC statistics, 94% of patient mortalities associated with …

Rural Hospital Execs Can Beat COVID-19 By Shifting From Reactive to Proactive Care Read More »

5 Trends Driving The Future of Healthcare Real Estate in 2020 & Beyond

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 these expectations. Health systems must be aware of current trends …

5 Trends Driving The Future of Healthcare Real Estate in 2020 & Beyond Read More »

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.

NAHC Pushing for Palliative Care, SNF-at-Home Medicare Benefits

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 post-acute care for years to come. That was the message …

NAHC Pushing for Palliative Care, SNF-at-Home Medicare Benefits Read More »

Home Health Value-Based Purchasing Model Set for Nationwide Expansion in ‘Next Year or So’

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 — also known as the CMS Innovation Center — supports the …

Home Health Value-Based Purchasing Model Set for Nationwide Expansion in ‘Next Year or So’ Read More »

Payment Reform, COVID-19 May Derail a Unified Post-Acute Care Payment System

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 into 2020. The ongoing COVID-19 emergency has derailed a lot …

Payment Reform, COVID-19 May Derail a Unified Post-Acute Care Payment System Read More »

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 effect Jan. 1, 2021. Humana Inc. and leading renal care …

Humana, Fresenius Medical Care Expand Partnership to Improve Care Coordination for Medicare Advantage Members Read More »

Innovaccer Unveils Risk Adjustment Solution For Improved Coding Accuracy

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 Language Processing (NLP) to make risk predictions. Innovaccer, Inc., a …

Innovaccer Unveils Risk Adjustment Solution For Improved Coding Accuracy Read More »

Getting Beyond the Telehealth ‘Stop-Gap’ Mentality

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 physicians said they had started using telehealth to treat patients.   …

Getting Beyond the Telehealth ‘Stop-Gap’ Mentality Read More »

Trump Signs Funding Bill Restructuring Medicare Loan Repayment Terms

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 Wednesday, just two days before being flown to Walter Reed …

Trump Signs Funding Bill Restructuring Medicare Loan Repayment Terms Read More »

How Low-Code Solutions Reduce Headaches for Healthcare CIOs

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 few programmers who build new applications from scratch.   Yes, they …

How Low-Code Solutions Reduce Headaches for Healthcare CIOs Read More »

Congressman Vern Buchanan Urges CMS to Scrap PDGM’s 4.36% Behavioral Adjustment

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 home health care is 21.6% lower than what the U.S. …

Congressman Vern Buchanan Urges CMS to Scrap PDGM’s 4.36% Behavioral Adjustment Read More »

Accounting for the Social Determinants of Health During the COVID-19 Pandemic

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 nation’s mental and behavioral health. For some people, work-from-home plans …

Accounting for the Social Determinants of Health During the COVID-19 Pandemic Read More »

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 all, perhaps, the decision by the Centers for Medicare & …

Confessions of a Home Health Agency Owner: ‘CMS Is Trying to Put Agencies Like Mine Out of Business’ Read More »

Debunking Common PDGM Primary Diagnosis Myths

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 of rumors and myths floating around out there,” Robbi D. …

Debunking Common PDGM Primary Diagnosis Myths Read More »

More Than Half of All Home Health Agencies Have Treated COVID-19 Patients

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 year ahead. In light of the mild proposal, CMS only …

More Than Half of All Home Health Agencies Have Treated COVID-19 Patients Read More »

Senator Kirsten Gillibrand Pushes for Increased PPE, Telehealth Payment for In-Home Care Providers

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 and home care providers have been vocal about the challenges …

Senator Kirsten Gillibrand Pushes for Increased PPE, Telehealth Payment for In-Home Care Providers Read More »

CMS Announces New ‘Phased-In Approach’ to the Review Choice Demonstration

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 and Florida. Agencies in Illinois, Ohio and Texas will be …

CMS Announces New ‘Phased-In Approach’ to the Review Choice Demonstration Read More »

Home Health Agencies Aren’t ‘Upcoding’ to Maximize PDGM Reimbursement

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 automatically “upcode,” or pick the primary diagnosis code tied to …

Home Health Agencies Aren’t ‘Upcoding’ to Maximize PDGM Reimbursement Read More »

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) Office of Inspector General (OIG). The purpose of the OIG …

OIG: Medicare Overpaid $267M for Hospital In-Patient Claims with Post-Acute Transfers to Home Health Services Read More »

COVID-19 Underscores Why Certain Aspects of the American Healthcare System Should Change Forever

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 to provide healthcare for all in the event of calamity …

COVID-19 Underscores Why Certain Aspects of the American Healthcare System Should Change Forever Read More »

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 where the coronavirus isn’t the central driver of health care …

Budgeting for the Future: Kindred at Home, Johns Hopkins Home Care and Always Best Care Look Ahead to 2022 Read More »

W2O Acquires Discern Health to Strengthen Value-Based Care Capabilities

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 decades of experience in quality, health care measurement, and payment …

W2O Acquires Discern Health to Strengthen Value-Based Care Capabilities Read More »

The COVID-19 Downturn Triggers Jump in Medicaid Enrollment

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 people was less than many analysts predicted. One possible factor …

The COVID-19 Downturn Triggers Jump in Medicaid Enrollment Read More »

OIG: CMS Could Have Saved $192M with Stronger LUPA Oversight

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 Payment Adjustments (LUPAs) in home health care could have saved …

OIG: CMS Could Have Saved $192M with Stronger LUPA Oversight Read More »

Sharecare Acquires WhiteHatAI to Enhance Healthcare Payment Integrity

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. – Sharecare will integrate WhiteHatAI’s capabilities to foster deeper engagement …

Sharecare Acquires WhiteHatAI to Enhance Healthcare Payment Integrity Read More »

‘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 making a last-ditch effort to get CMS’s attention and persuade …

‘An Absolute Travesty’: Home Health Advocates Make Last-Ditch Effort to Delay Review Choice Demonstration Read More »

How ADT-Based E-Notifications Can Enable Better Safety for COVID-19 Patients

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 settings matter more than ever. In particular, hospitals sharing admission, …

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Ambulance Crews and In-Home Care Providers Seek Collaboration — Not Competition

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 — have always provided some degree of care in the home …

Ambulance Crews and In-Home Care Providers Seek Collaboration — Not Competition Read More »

PDGM Data Shows Reality-Versus-Expectations Mismatch for Case-Mix Components

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) data unveiled on a recent BlackTree Healthcare Consulting webinar. The …

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The Number of Medicare-Certified Home Health Agencies Is Dwindling

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 of 427 individual providers, according the Medicare Payment Advisory Commission …

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‘I’m Not Sure Their Timing Could Be Any Worse’: CMS to Resume Review Choice Demonstration

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 forward with the demonstration “regardless of the status of the …

‘I’m Not Sure Their Timing Could Be Any Worse’: CMS to Resume Review Choice Demonstration Read More »

Despite COVID-19 Resurgence, Home Health Agencies Likely to Avoid Another Sudden Admissions Drop

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 York metropolitan area in a matter of days, many hospitals …

Despite COVID-19 Resurgence, Home Health Agencies Likely to Avoid Another Sudden Admissions Drop Read More »

Doctor On Demand Raises $75M to Expand Comprehensive Virtual Care Platform

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 On Demand, today announced it has raised $75 million in …

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Hospital Wayfinding: The Next Frontier in Healthcare Design

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 lost revenue on the problems patients have navigating these facilities. …

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Time for Policymakers, Hospitals to Bet Big on Home-Based Care

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 technology and the shift away from brick-and-mortar medical appointments. In …

Time for Policymakers, Hospitals to Bet Big on Home-Based Care Read More »