Though the price transparency rule aims to make it easier for healthcare consumers to compare prices, there is a lack of standardization in how hospitals present the data, making it hard for consumers to shop around for care, a new analysis shows.
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… Read More »How CMS final rule will impact E/M coding and documentation requirements
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… Read More »Boost Operational, Clinical and Financial Performance with Good Data
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… Read More »Indiana’s Medicaid Expansion — Designed by Pence and Verma — Panned in Federal Report
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.… Read More »What Home Health Providers Need to Know About Medicare Loan Recoupment
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… Read More »Hospital-at-Home Holdouts: Why In-Home Acute Care Isn’t for the Faint of Heart
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… Read More »How the Pandemic is Accelerating the Shift to Alternative Care Delivery Models
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.… Read More »Under New Cost-Cutting Medicare Rule, Same Surgery, Same Place, Different 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.),… Read More »With Time Running Out, House Passes Medicare Sequestration Bill
The federal price transparency rule for hospitals went into effect Jan. 1, but a new analysis shows that a majority of providers studied were “unambiguously noncompliant.”
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… Read More »CMS Increases Vaccine Reimbursement for Home Health Providers, Others
CMS has increased the Medicare payment rate to $40 for administering single-dose Covid-19 vaccines and $80 for two-dose vaccines. The payment increase aims to support providers as they ramp up vaccine administration.
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… Read More »OIG Sets Guidelines for Hospitals Referring to Home Health Providers
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… Read More »Waystar Launches Price Transparency Solutions to Meet Consumer Demand
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.
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… Read More »Payers Struggle with Provider Data Management Too
A new CMS rule would require insurers to cover Covid-19 tests, even for asymptomatic patients. It builds on previous legislation requiring payers to cover the cost of both testing and vaccines for their members.
President Joe Biden’s pick for CMS administrator, Chiquita Brooks-LaSure, is slated to become the first Black woman to hold the post. Her policy priorities will likely center on healthcare access, including expanding insurance coverage, and health equity.
As Texas reels from a devasting winter storm, HHS is issuing several waivers to help hospitals continue to provide care amid mounting challenges. These waivers allow non-compliance with certain HIPAA provisions and other federal regulations.
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… Read More »Medicare Cuts Payment to 774 Hospitals Over Patient Complications
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)… Read More »Home Health Experts Offer Update on Transition to No-Pay RAPs
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,… Read More »Home Health Value-Based Purchasing Model Could Limit Access to Care, Critics Caution
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… Read More »Health Plans Must Go Beyond the ONC Mandate and Prioritize Member Experience
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.
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.
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… Read More »As Becerra Awaits HHS Confirmation, Biden Reportedly Narrows Picks to Head CMS
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,… Read More »COVID-19 Funding Presents an ‘Enforcement Perfect Storm’ for Home Health Providers, Others
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… Read More »KHN’s ‘What the Health?’: The Long Road to Unwinding Trump Health Policies
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… Read More »A New System to Fit A New Economy: How Healthcare Can Recover From COVID-19
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… Read More »Why CMS Will Lead the 2021 Kidney Care Revolution
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… Read More »MACs Report Processing Glitches for No-Pay RAPs
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… Read More »Biden Administration Includes ‘Home Care Workforce Crisis’ in New Pandemic Plan
Dr. Micky Tripathi will lead the ONC as the new national coordinator for health information technology, while agency veterans Liz Richter and Norris Cochranwill serve as interim leaders for CMS and HHS, respectively.
“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… Read More »Top Home Health Trends for 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,… Read More »Provider Strategies for Mitigating Telehealth Fraud & Abuse in 2021
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… Read More »New CMS rule to enable immediate coverage for FDA-designated ‘breakthrough’ devices
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,… Read More »National Expansion of Home Health Value-Based Purchasing Model Estimated to Create $6.3B in Savings
In a wide-ranging discussion at J.P. Morgan’s Annual Healthcare Conference, former CMS Administrator Andy Slavitt talked about the future of the ACA, telehealth and Medicare Advantage with a Democrat-led House, Senate and presidency.
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… Read More »HHS Announces Plans to Expand the Home Health Value-Based Purchasing Model
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… Read More »Trump Administration Approves First Medicaid Block Grant, in Tennessee
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… Read More »Xealth’s CEO Shares Impact of Digital Health in 2020 and What’s Ahead in 2021
Back in 2019, the Proposed Interoperability rules were released from ONC and CMS, and the […]
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… Read More »UNC Health Rolls out Hospital-at-Home Program with Medically Home
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… Read More »CMS Approves 5 More Hospitals for Hospital-at-Home Initiative, Raising Total to 56
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… Read More »12 Telehealth & Virtual Care Predictions and Trends for 2021 Roundup
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… Read More »MA Beneficiaries See Nearly 20% Fewer Home Health Days Than Traditional Medicare Peers
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… Read More »CIO: 3 Rules for Meeting ONC/CMS Interoperability, While Improving Cybersecurity
A federal appeals court has ruled against hospital groups in their legal challenge to the CMS regulation that would require hospitals to make pricing information publicly available. The rule is set to take effect Jan. 1.
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… Read More »30 Executives Share Top Healthcare Predictions & 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)… Read More »5 Post-Acute Care Industry Trends to Watch in 2021
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… Read More »For Better Patient Care Coordination, We Need Seamless Digital Communications
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… Read More »Stimulus Money, Therapy Changes and COVID-19 Strategies: Top Home Health Stories of 2020
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… Read More »National Home Health Spending Reaches All-Time High of $113.5 Billion
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… Read More »American Academy of Home Care Medicine Urges CMS to Reconsider Rate Cut for Home-Based Primary Care
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”… Read More »Landmark Health Gearing Up for Direct-Contracting Participation
Multicare rolled out a hospital-at-home program with Denver-based startup Dispatch Health. The program will free up hospital beds and staff as Covid-19 cases surge across the U.S.
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.”
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,… Read More »As Telehealth Surges, Are Seniors Being Left Behind?
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.… Read More »Despite COVID-19: Providers Should Not Lose Sight of MIPS Compliance
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.
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 &… Read More »Pair Team Emerges Out of Stealth with $2.7M to Automate Primary Care Operations
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… Read More »Ensuring Telehealth Providers’ Virtual Care Dollars Make Sense
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… Read More »House Bill Looks to Keep Medicare Sequestration ‘Holiday’ in Place for Home Health Agencies, Others
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… Read More »5 Steps for Interoperability Excellence for Healthcare Providers
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… Read More »‘An Arm and a Leg’: Obamacare Alum Andy Slavitt Takes Stock of the COVID Pandemic — So Far
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… Read More »CommonHealth App Connects to 230 Health Systems to Share Health Data – including COVID Test and Vaccine Status
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… Read More »5 Myth-Busting New Hospital ADT Notification Requirements
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… Read More »CMS Announces New Direct-Contracting Model to Promote ‘Easier Access to Home Care’
New interoperability rules hold promise in making it easier for patients to access and share their health data. But there’s still a long way to go to make a health records turnkey.
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… Read More »New CMS Hospital-at-Home Program Could Boost Business for Home Health Agencies
The final physician payment rule for next year includes changes to the list of telehealth services covered by Medicare and updated payment policies for remote physiologic monitoring.
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… Read More »Brigham and Women’s, Biofourmis launch hospital-at-home solution nationwide
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… Read More »New Hospital-at-Home Waiver Program Is ‘Another Step Forward’ for Home-Based Care
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… Read More »Non-Physician Certification in Home Health Care Blocked by State-Level Barriers
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… Read More »CMS’s Stark Law Changes Could Mean More Value-Based Business for Home Health Operators
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… Read More »CMS Launches ‘Unprecedented’ Hospital-at-Home Strategy to Manage Latest COVID-19 Surge
CMS has finalized changes to the Physician Self-Referral Law, also known as Stark Law. Healthcare law experts say that these changes will generally make it easier for hospitals and physicians to remain in compliance with the statute.
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… Read More »COVID-19: How Can Payers Prepare for Mandates and Support Pandemic Relief Efforts
The U.S. Centers for Medicare & Medicaid Services (CMS) is moving forward with its plan to retire the old Home Health Compare in favor of a new, multi-setting tool known simply as “Care Compare.” By Dec. 1, CMS will move away from Home Health Compare,… Read More »CMS to Retire Home Health Compare Next Month
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… Read More »LHC Group CEO Keith Myers: Change in Washington Won’t Derail ‘Incredible’ Home Health Opportunity
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… Read More »An ‘Awkward Transition Year’: Why 2021 Will Look Different in Home Health with New RAP Adjustments
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… Read More »CMS: Home Health Improper Payments Down by $5.9B Since 2016
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.… Read More »How TRU Community Care Used Telehealth to Revamp Its Palliative Care Program
CMS will cover monoclonal antibody treatments for Medicare beneficiaries with Covid-19. Though this is a step forward in increasing access to these treatments, there are still hurdles to its widespread use.
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”… Read More »8 Ways Advanced Analytics Can Help You Decide If Telehealth Should Be Temporary or Permanent
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… Read More »To Solve Healthcare Interoperability, We Must ‘Solve the Surround’
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… Read More »Sony Updates NUCLeUS Medical Imaging Platform to Support Remote Patient Observation
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… Read More »Q&A with Experian Health senior director of data compliance on CMS updates for Medicare ABN forms
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… Read More »Feds Approve Fractious Georgia Plan to Change ACA Marketplace
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… Read More »Verma: Older Adults Must Have a ‘More Robust’ Set of Home Care Options
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… Read More »Medicare Fines Half of Hospitals for Readmitting Too Many Patients
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… Read More »Late RAPs Could Trigger Immediate 20% Payment Reduction in 2021
The final rule requires insurers to disclose information on prices for healthcare services and cost-sharing with patients. The government says it will help lower prices, but insurers aren’t so sure.
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… Read More »[Updated] CMS Finalizes 1.9% Home Health Rate Increase for 2021, Keeps PDGM’s Behavioral Adjustment
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… Read More »The Trump Medicaid Record: Big Goals, Yet Few Successes
CMS’ interim rule states that Medicare will cover Covid-19 vaccines approved by the FDA, including those receiving emergency use authorization, in a reversal from its usual policy. The vaccine will be made available at no cost to Medicare beneficiaries.
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