CMS

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

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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

HHS issues HIPAA, CMS regulatory waivers to Texas hospitals

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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.

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

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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

Why hospitals want CMS, FTC to examine two UnitedHealthcare policies

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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.

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

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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

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

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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

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

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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

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

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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

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

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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

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

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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

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

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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

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

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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

For Better Patient Care Coordination, We Need Seamless Digital Communications

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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

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

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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

CMS proposed rule requires payers to streamline prior authorizations

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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.”

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

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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.

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

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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

5 Steps for Interoperability Excellence for Healthcare Providers

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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

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

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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

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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

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

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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

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

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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

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

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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

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

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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

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

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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

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

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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

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

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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

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

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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

Sony Updates NUCLeUS Medical Imaging Platform to Support Remote Patient Observation

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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

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

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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

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

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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

Medicare to cover all FDA-approved Covid-19 vaccines

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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.

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

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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

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

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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

Nebraska gets approval to add work requirements to Medicaid expansion

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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.

CMS promises a plan for Medicare to cover coronavirus vaccine

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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.

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

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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’

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

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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

Innovaccer Unveils Risk Adjustment Solution For Improved Coding Accuracy

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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

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

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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

CMS to penalize hospitals, labs that don’t report Covid-19 data

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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’

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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’

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

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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

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

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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

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

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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

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

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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

Congress, states hold the keys to telehealth expansion

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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.

Trump executive order targets rural telehealth expansion

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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

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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

W2O Acquires Discern Health to Strengthen Value-Based Care Capabilities

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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

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

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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

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

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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

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

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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

House bill would cement Medicare telehealth changes

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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.

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

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

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… Read More »Doctor On Demand Raises $75M to Expand Comprehensive Virtual Care Platform