Category: CMS

  • Flawed design is why hospitals are not complying with price transparency rules

    Experts believe CMS’ price transparency rule is flawed in its design because the highly complex billing data it is asking hospitals to post is too confusing for consumers to understand. The complicated structure of the healthcare system — from care variance to deductibles to billing codes — means that producing an accurate price estimate is […]

  • Home Health Industry Pushes Back on CMS Budget-Neutrality Methodology for PDGM

    Since the release of the U.S. Centers for Medicare & Medicaid Services’ (CMS) proposed payment rule, home health stakeholders have been sitting in their respective “war rooms” trying to navigate the proposal. As providers geared up for the unveiling of the proposal, many knew that CMS’ analysis of whether the Patient-Driven Groupings Model (PDGM) led […]

  • The Home Health Proposed Rule’s Impact on M&A Activity

    With the uncertainty surrounding the U.S. Centers for Medicare & Medicaid Services’ (CMS) new proposed payment rule, buyers and sellers in the M&A industry will be proceeding with caution. Home health insiders told Home Health Care News that while the proposed rule is sure to create some pause in overall activity, it shouldn’t be considered […]

  • ‘A Declaration of War’: Inside the 2023 Home Health Proposed Payment Rule

    The U.S. Centers for Medicare & Medicaid Services (CMS) effectively went to war with home health providers when the agency unveiled its 2023 proposed payment rule on June 17. At the heart of the conflict is differing views on how the Patient-Driven Groupings Model (PDGM) has impacted the industry. Ultimately, CMS estimates that its proposal […]

  • What Hospital Success Looks Like Under Value-Based Care

    Mike Ipekdjian, MBA-HM, BSN, RN, SANE, PHRN, NREMT, Head of Clinical & Solution Hospitals are increasingly turning to value-based care initiatives to transform care delivery, lower the total cost of care, and improve patient outcomes. Unlike traditional fee-for-service (FFS) models that reimburse providers based on volume (i.e., the number of patient visits), providers are reimbursed […]

  • Buy and Bust: When Private Equity Comes for Rural Hospitals

    MEXICO, Mo. — When the new corporate owners of two rural hospitals suddenly announced they would stop admitting patients one Friday in March, Kayla Schudel, a nurse, stood resolute in the nearly empty lobby of Audrain Community Hospital: “You’ll be seen; the ER is open.” The hospital — with 40 beds and five clinics — […]

  • The No Surprises Act: How Payers Can Stay Compliant

    Michael Gardner, Chief Strategy Officer at Virsys12 As the healthcare system continues to evolve to adopt a more patient-centric approach, surprise billing has become a topic discussed by consumers and policymakers. Surprise billing can occur when a patient unknowingly receives care from providers that are outside their network. This can result in balance billing, the […]

  • Medicaid Weighs Attaching Strings to Nursing Home Payments to Improve Patient Care

    The Biden administration is considering a requirement that the nation’s 15,500 nursing homes spend most of their payments from Medicaid on direct care for residents and limit the amount that is used for operations, maintenance, and capital improvements or diverted to profits. If adopted, it would be the first time the federal government insists that […]

  • They Thought They Were Buying Obamacare Plans. What They Got Wasn’t Insurance.

    Tina Passione needed health insurance in a hurry in December. The newly retired 63-year-old was relocating to suburban Atlanta with her husband to be closer to grandchildren. Their house in Pittsburgh flew off the market, and they had six weeks to move out 40 years of memories. Passione said she went online to search for […]

  • HHS Extends States’ Deadline to Utilize American Rescue Plan’s HCBS Funding

    On Friday, the U.S. Department of Health and Human Services (HHS) – through the U.S Centers for Medicare & Medicaid Services (CMS) – announced that states would have an additional year to use funding from the American Rescue Plan to both enhance and expand home- and community-based services (HCBS). The news is major for home-based […]

  • Is It Finally Time for Hospital-at-Home or is Time Up?

    Karen Conway, VP of Healthcare Value, Global Healthcare Exchange (GHX) All the signs point to a bright and expansive future for hospital-at-home programs, which have been growing steadily since the Centers for Medicare and Medicaid (CMS) created the Acute Hospital at Home waiver program in November 2020. As of March, nearly 100 health systems and […]

  • Aneesh Chopra: Greater ACO enrollment will bolster preventive care

    The Biden administration set a goal of ensuring all Medicare beneficiaries are enrolled in alternative payment models by 2030. Aneesh Chopra, the federal government’s first-ever chief technology officer and currently the CEO of CareJourney, says this push for alternative payment models will lead not only to a reduction in unnecessary expenditures, but also higher preventive […]

  • How Patient Movement Benefits from Standardized Acuity Scoring

    Dr. Martin Sellberg, Co-Founder of Motient Nurses and providers typically assess patient acuity and volume at the beginning of their shift, whether formally or informally. Managers use patient acuity to balance nursing assignments, and nursing staff uses it to determine which patient care action should be prioritized next. Taking a standardized approach to acuity assessments […]

  • What HHVBP Means for Managed Care, SNF Utilization

    With the nationwide rollout of the Home Health Value-Based Purchasing (HHVBP) Model inching closer, home health agencies are feeling confident about their ability to adapt. Not only are operators confident, but some are even excited about what HHVBP might translate to in terms of improved managed care relationships and further diversion away from skilled nursing […]

  • 3 Senior Living Providers Merge to Form Curana Health

    What You Should Know: – Three leading organizations that provide healthcare services to senior living communities – Elite Patient Care, Provider Health Services, and AllyAlign Health – have joined forces to form Curana Health. Curana Health’s mission is to improve the health, happiness, and dignity of senior living residents. The Curana Health ACO is a value-based […]

  • Home Health Providers Should Prepare For Increased Scrutiny Due to Nursing Home Sector Reforms

    With the unveiling of the Biden administration’s nursing home reforms, which include increased health and safety inspections by the U.S. Centers for Medicare & Medicaid Services (CMS), home health providers will need to be prepared to navigate through additional oversight. In February, the Biden administration released a full-scale set of proposed reforms. The reforms are […]

  • Probe finds Medicare Advantage plans deny needed care to tens of thousands

    Medicare Advantage Organizations (MAOs) delayed or denied payments and services to patients, even when these requests met Medicare coverage rules, according to a report released by federal investigators on Thursday. The Office of Inspector General (OIG) for the Department of Health and Human Services (HHS) reviewed a random sample of 250 prior authorization denials and […]

  • What the New CMS Staff Turnover Data Means for Nursing Homes

    Ben Tengelson, VP of Data Science at IntelyCare To make it easier for families and caregivers to evaluate the quality of nursing homes, the Center for Medicare & Medicaid Services (CMS) regularly publishes data on its “Care Compare” website. Anyone can go to the site and search for a facility to find COVID updates, quarterly […]

  • Analysis: CMS Data Underestimates Hospital Labor Spending

    What You Should Know: – Centers for Medicare & Medicaid Services’ (CMS) payment adjustments did not adequately address hospitals increased costs for FY 2021, according to new data from Premier. – The data reveals this discrepancy has resulted in hospitals receiving only a 2.4 percent rate increase, compared to a 6.5 percent increase in hospital labor rates, which account for 76 […]

  • Why Home Health Agencies Could See an Unfavorable Medicare Payment Landscape in 2023

    Home health operators should dig in even further ahead of the Medicare reimbursement battle coming later this year. The U.S. Centers for Medicare & Medicaid Services (CMS) released its 2023 proposed payment rule for the nursing home industry earlier this month. In it, the agency called for a 3.9% increase to Medicare payments for skilled […]

  • Why a Focus on Behavioral Health is Key to Improving Quality Measures

    Tom Zaubler, MD, Chief Medical Officer of NeuroFlow Since the passage of the Medicare Improvements for Patients & Providers Act in 2008, the U.S. healthcare system has been moving towards value-based care (VBC) which encourages health providers to improve care quality by reimbursing them based on successful outcomes rather than individual medical services. The overarching […]

  • Where the Director of the Center for Medicare Wants to See Care Go

    One of the most important Centers for Medicare & Medicaid Services (CMS) leaders – Dr. Meena Seshamani – is very optimistic about the future of the home health care industry. She detailed why last month at Home Health Care News’ Capital+Strategy event, pointing to more and more care taking place outside of traditional facilities, emerging […]

  • HHS Renews Public Health Emergency, Keeping Key Home Health Waivers in Place

    The U.S. Department of Health and Human Services (HHS) on Wednesday opted to renew the COVID-19 public health emergency (PHE), keeping in place several regulatory waivers that have been critical lifelines for home health and hospice operators since the start of 2020. While the extension itself is not surprising, it offers further stability as operators […]

  • Who Doesn’t Text in 2022? Most State Medicaid Programs

    West Virginia will use the U.S. Postal Service and an online account this summer to connect with Medicaid enrollees about the expected end of the covid public health emergency, which will put many recipients at risk of losing their coverage. What West Virginia won’t do is use a form of communication that’s ubiquitous worldwide: text […]

  • IntelyCare Secures $115M for Intelligent Nurse Staffing Platform at $1.1B Valuation

    What You Should Know: – IntelyCare, a leading intelligent workforce management solution for post-acute facilities raises $115M to solve the nationwide nurse shortage. – IntelyCare plans to build on this momentum by using the new funding to expand its footprint to new states and invest heavily in its AI-based platform and data science technology. IntelyCare, […]

  • Will health care spending as a share of the economy fall?

    In the short-run, the answer is likely ‘yes’. As COVID-19 (hopefully) slows and if economic growth remains strong, health care spending will fall as a share of the US economy. At least this is what the Office of the Actuary (OACT) at Centers for Medicare and Medicaid Services (CMS) thinks in their Health Affairs study […]

  • Home Health Agencies Should Brace for PDGM Battle Later This Year

    Home health providers should brace themselves for a potential Patient-Driven Groupings Model (PDGM) battle with the U.S. Centers for Medicare & Medicaid Services (CMS) later this year. Implemented on Jan. 1, 2020, PDGM is the largest overhaul to how Medicare-certified home health agencies are paid in two decades. And normally when CMS implements something of […]

  • CMS Giving States $110 Million to Boost Money Follows the Person Programs

    The U.S. Centers for Medicare & Medicaid Services (CMS) announced Thursday it will distribute more than $110 million to expand access to home- and community-based services (HCBS) through Medicaid’s Money Follows the Person (MFP) program. The MFP demonstration began in 2007 and was funded by the Affordable Care Act through 2016. The goal of the […]

  • KHN’s ‘What the Health?’: Funding for the Next Pandemic

    Can’t see the audio player? Click here to listen on Acast. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts, or wherever you listen to podcasts. President Joe Biden released his budget proposal for 2023 this week, and it calls for a nearly 27% increase in funding for the Department of Health and […]

  • National Home Health Spending Dips to $129.1 Billion as Health Care Sector Normalizes

    U.S. health care expenditures ballooned in 2020 because of the COVID-19 pandemic, but they’re starting to normalize. National home health spending, in turn, experienced a comparatively small decline over the past year. That’s according to the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS), which published its annual spending analysis […]

  • What The Finance Industry Can Teach Healthcare About Digital Transformation

    Mike Serbinis, Co-Founder and CEO of League The COVID-19 pandemic feels like a once-in-a-lifetime event for those of us involved in healthcare, but the patterns of how the crisis affected our industry feel familiar. Stop me if you have heard this before: incumbent players in a broad industry made very slow and fragmented technological advances […]

  • Home-Based Care Providers Sue CMS, HHS Over COVID-19 Relief Funds

    A group of New York home-based care providers are taking aim at the Department of Health and Human Services (HHS), the New York State Department of Health (NYSDOH) and the U.S. Centers for Medicare & Medicaid Services (CMS) in a lawsuit filed Friday. Broadly, the case alleges unfair distribution of funds from the American Rescue […]

  • North Carolina, Florida Home Health Providers Navigate RCD Changes

    The U.S. Centers for Medicare & Medicaid Services (CMS) is giving home health providers in North Carolina and Florida time to acclimate to the full implementation of Review Choice Demonstration (RCD). For providers in North Carolina and Florida, the rollout of RCD has meant keeping an eye out for key changes.  Broadly, the purpose of […]

  • TimeDoc Health Secures $48.5M to Scale Virtual Care Management Platform

    What You Should Know: – TimeDoc Health, a Chicago-based provider of virtual care management activation, today announced it has closed a $48.5M Series B round led by Aldrich Capital Partners. – Founded in 2015, TimeDoc Health partners with PCPs and healthcare organizations to automate record-keeping for clinician/patient interactions (in-person and virtual), sending the reports to […]

  • Healthgrades Releases Top 24 Hospitals Leading Early COVID Care

    What You Should Know: – Healthgrades announced its Leading Hospitals in Early COVID Care list of the top 24 U.S. hospitals that provided exceptional care while treating the highest volumes of coronavirus patients during the first wave of the pandemic. Methodology Background Using inpatient data from CMS for almost every hospital in the country, Healthgrades identified 24 […]

  • 2022 Infusion Industry Outlook: Adapting Care Delivery to Meet New Realities

    Roger Massengale, Chief Commercial Officer, Eitan Medical January 2022 marked two years since the outbreak of COVID-19, with the healthcare system still working to adjust to a very challenging new reality. However, these challenges have served as a catalyst for important shifts within the healthcare industry, some of which are poised to be a significant […]

  • Biden Pledges Better Nursing Home Care, but He Likely Won’t Fast-Track It

    President Joe Biden’s top Medicare official suggested Wednesday that forthcoming rules to bolster nursing home staffing won’t be issued under a4 mechanism, known as interim final rules, that would allow regulations to take effect more or less immediately. “While we want to move swiftly, we want to get comments from stakeholders,” Chiquita Brooks-LaSure, administrator of […]

  • Biden’s Promise of Better Nursing Home Care Will Require Many More Workers

    The Biden administration has identified core impediments to better nursing home care in its proposed overhaul of the industry, but turning aspirations into reality will require a complex task: mandating adequate staffing levels for all homes without bankrupting those that can’t afford far higher labor costs. President Joe Biden’s proposals for the nation’s 15,000 skilled […]

  • Why Medicaid Programs Need to Update Their Information Systems

    Brett Furst, President, HHS Technology Group You don’t have to be a news junkie or political aficionado to know that state unemployment information systems massively failed during the COVID-19 pandemic at a time when they were most desperately needed. Overwhelmed by a rush of newly laid-off workers, websites crashed and timed out while phone lines […]

  • What the ACO REACH Model Means for Direct Contracting’s Future

    A new path was laid out last week for home-based care providers wishing to engage in direct contracting with the federal government. As the U.S. Centers for Medicare & Medicaid Services (CMS) announced Thursday, the Global and Professional Direct Contracting (GPDC) Models will expire at the end of 2022. On Jan. 1, 2023, the accountable […]

  • Butterfly Launches System-Wide Ultrasound w/AI-Guided Option

    What You Should Know: – Butterfly Network today launched Butterfly Blueprint, a system-wide platform that supports scaled deployment of ultrasound across hospitals and health systems. – Blueprint integrates ultrasound information into health systems’ clinical and administrative systems and workflows. That means clinicians across all disciplines now have a tool that allows them to see and know results sooner to drive better care decisions, efficiency and outcomes. Blueprint […]

  • Inside the Tactical Tug of War Over the Controversial Alzheimer’s Drug

    The drug industry, patient advocates, and congressional Republicans have all attacked federal officials’ decision to decline routine Medicare coverage for a controversial Alzheimer’s drug. They’ve gone as far as to accuse them of tacit racism, ageism, and discrimination against the disabled — and hinted at a lawsuit — over the decision to pay only for […]

  • Leveraging A More Impactful Analytics Strategy to Improve Your Health Plan Member CX

    Suzanne Cogan, General Manager, SPH Analytics, a Press Ganey Solution Healthcare organizations are increasingly eager to leverage analytics technologies, including machine learning and artificial intelligence (AI), in new ways. One telling sign of this is that the global predictive analytics healthcare market, which was valued at $1.8 billion in 2017, is projected to reach more […]

  • Why Millions on Medicaid Are at Risk of Losing Coverage in the Months Ahead

    The Biden administration and state officials are bracing for a great unwinding: millions of people losing their Medicaid benefits when the pandemic health emergency ends. Some might sign up for different insurance. Many others are bound to get lost in the transition. State Medicaid agencies for months have been preparing for the end of a […]

  • KHN’s ‘What the Health?’: FDA Takes Center Stage

    Can’t see the audio player? Click here to listen on Acast. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts. The FDA is still lacking a Senate-confirmed leader, but the agency is at the center of several major policy battles. Lawmakers this year must renew the bill […]

  • Skirmish Between Biden and Red States Over Medicaid Leaves Enrollees in the Balance

    When Republican-led states balked at expanding Medicaid under the Affordable Care Act, President Barack Obama’s administration tossed them a carrot — allowing several to charge monthly premiums to newly eligible enrollees. Republicans pushed for the fees to give Medicaid recipients “skin in the game” — the idea they would value their coverage more — and […]

  • Health Care Paradox: Medicare Penalizes Dozens of Hospitals It Also Gives Five Stars

    The federal government has penalized 764 hospitals — including more than three dozen it simultaneously rates as among the best in the country — for having the highest numbers of patient infections and potentially avoidable complications. The penalties — a 1% reduction in Medicare payments over 12 months — are based on the experiences of […]

  • At Nursing Homes, Long Waits for Results Render Covid Tests ‘Useless’

    More nursing homes are waiting longer for covid-19 test results for residents and staffers, according to federal data, making the fight against record numbers of omicron cases even harder. The double whammy of slower turnaround times for lab-based PCR tests and a shortage of rapid antigen tests has strained facilities where quickly identifying infections is […]

  • Medicare Patients Win the Right to Appeal Gap in Nursing Home Coverage

    A three-judge federal appeals court panel in Connecticut has likely ended an 11-year fight against a frustrating and confusing rule that left hundreds of thousands of Medicare beneficiaries without coverage for nursing home care, and no way to challenge a denial. The Jan. 25 ruling, which came in response to a 2011 class-action lawsuit eventually […]

  • Families Complain as States Require Covid Testing for Nursing Home Visits

    As covid-19 cases rise again in nursing homes, a few states have begun requiring visitors to present proof that they’re not infected before entering facilities, stoking frustration and dismay among family members. Officials in California, New York, and Rhode Island say new covid testing requirements are necessary to protect residents — an enormously vulnerable population […]

  • CMS Solidifies Vaccination Deadlines, Releases Guidance for Home Health Agencies

    The U.S. Supreme Court on Thursday threw its support behind the nationwide COVID-19 vaccine mandate for health care workers, while simultaneously axing a vaccine-or-test rule for large employers. Last week’s developments shouldn’t shock the in-home care operators that have been following the U.S. Centers for Medicare & Medicaid Services (CMS) and Occupational Safety and Health […]

  • [Updated] Supreme Court Blocks OSHA Mandate, Allows CMS Rule to Take Effect

    The long-awaited decisions regarding the Biden administration’s vaccine mandates have finally arrived from the U.S. Supreme Court. In the end, the Occupational Safety and Health Administration (OSHA) “soft” mandate was shot down by SCOTUS by a 6-3 count. The mandate would have applied to all private businesses with 100 employees or more, requiring workers to […]

  • Supreme Court Weighs Biden’s Workplace Vaccine Requirements

    The Supreme Court on Friday took up one of the most contentious issues of the covid-19 pandemic, hearing a series of cases challenging the Biden administration’s authority to require workers to get a covid vaccine or be tested for the virus regularly. The issue in the cases, which challenge rules set in November by the […]

  • CMS Releases Vaccine Mandate Guidance for Home Health Providers

    The U.S. Centers for Medicare & Medicaid Services (CMS) released guidance on evaluating providers’ compliance with the federal COVID-19 vaccination mandate for health care workers. Although CMS originally published the interim final rule in November, it posted the guidance for state survey agency directors on Tuesday. Broadly, the guidance applies to providers working under the […]

  • After ‘Truly Appalling’ Death Toll in Nursing Homes, California Rethinks Their Funding

    SACRAMENTO, Calif. — About 1 in 8 Californians who have died of covid lived in a nursing home. They were among the state’s most frail residents: nearly 9,400 mothers, fathers, grandparents, aunts and uncles whom Californians entrusted to a nursing home’s care. An additional 56,275 confirmed covid cases among nursing home residents weren’t fatal. “The […]

  • Appeals court declines to reinstate CMS’ vaccine mandate 

    A panel of judges on the 8th Circuit Court of Appeals declined to reinstate a vaccine mandate for healthcare workers that was set to go into effect in January. A federal judge had blocked the mandate last month from the Centers for Medicare and Medicaid Services after 10 states filed suit.  

  • Post-Pandemic, What’s a Phone Call From Your Physician Worth?

    Maybe this has happened to you recently: Your doctor telephoned to check in with you, chatting for 11 to 20 minutes, perhaps answering a question you contacted her office with, or asking how you’re responding to a medication change. For that, your doctor got paid about $27 if you are on Medicare — maybe a […]

  • Federal Judge Halts Health Care Worker Vaccine Mandate Nationwide

    The health care worker vaccine mandate is now on ice. A federal judge on Tuesday issued a preliminary injunction to stop the start of the national vaccine mandate for all providers covered by the Medicare and Medicaid Conditions of Participation (CoPs), a group that includes home health agencies. The move comes just one day after […]

  • CMS Vaccine Mandate Blocked in 10 States

    First it was the COVID-19 vaccination mandate from the U.S. Occupational Safety and Health Administration (OSHA). Now, it’s the one from the Centers for Medicare & Medicaid Services (CMS). Since OSHA and CMS released their interim emergency regulations requiring COVID-19 vaccinations for certain individuals, each has been challenged in court. On Monday, a federal judge […]

  • ‘Be Vigilant’: What In-Home Care Providers Should Know About the Omicron Variant

    The World Health Organization (WHO) on Friday officially designated the COVID-19 variant Omicron as “a variant of concern.” The U.N. agency on Monday followed that up by warning the global risk from Omicron is “very high” based on early evidence, noting the variant could have “severe consequences” as far as future surges. While there’s still […]

  • An Inside Look at Payer Compliance with CMS’ Patient Access API Rule

    John Kelly, Principal Business Advisor, Edifecs The healthcare industry is now closer than ever to its quest for true interoperable data exchange. July 1, 2021 was the enforcement date for the Centers for Medicare and Medicaid Services (CMS) Interoperability and Patient Access final rule. The rule requires that all healthcare payer organizations participating in a CMS program allow members to download and share their data using API’s […]

  • Home Health Improper Payments Increased to $1.84 Billion in 2021

    The Centers for Medicare & Medicaid Services (CMS) announced Monday it continues to see a major decrease in improper payments to providers, though not necessarily in the home health setting. Specifically, the agency said that there has been a $20.72 billion reduction in Medicare fee-for-service improper payments since 2014. “CMS is undertaking a concerted effort […]

  • CMS scraps coverage rule for breakthrough devices

    The agency decided to rescind a rule by the previous administration where Medicare would be required to cover breakthrough devices for up to four years after they receive FDA approval or clearance. CMS said it made the change to address safety concerns with the policy.

  • La inscripción de Medicare es temporada abierta para estafadores

    Encontrar el mejor plan médico privado, o de medicamentos, de Medicare entre docenas de opciones es lo suficientemente difícil sin incluir estrategias de venta engañosas. Sin embargo, funcionarios federales dicen que están aumentando las quejas de personas mayores engañadas para que compren pólizas sin su consentimiento, o atraídas por información cuestionable, que pueden no cubrir […]

  • Researcher: Medicare Advantage Plans Costing Billions More Than They Should

    Switching seniors to Medicare Advantage plans has cost taxpayers tens of billions of dollars more than keeping them in original Medicare, a cost that has exploded since 2018 and is likely to rise even higher, new research has found. Richard Kronick, a former federal health policy researcher and a professor at the University of California-San […]

  • Medicare’s Open Enrollment Is Open Season for Scammers

    Finding the best private Medicare drug or medical insurance plan among dozens of choices is tough enough without throwing misleading sales tactics into the mix. Yet federal officials say complaints are rising from seniors tricked into buying policies — without their consent or lured by questionable information — that may not cover their drugs or […]

  • CMS Finalizes Home Health Value-Based Purchasing Expansion, 3.2% Rate Increase

    It’s official: Providers everywhere will soon be subject to the Home Health Value-Based Purchasing (HHVBP) Model. The first performance year of the expanded initiative — recognized as one of the most successful alternative payment models ever — will be calendar year 2023. The U.S. Centers for Medicare & Medicaid Services (CMS) released the 2022 home […]

  • Look Up Your Hospital: Is It Being Penalized By Medicare?

    Under programs set up by the Affordable Care Act, the federal government cuts payments to hospitals that have high rates of readmissions and those with the highest numbers of infections and patient injuries. For the readmission penalties, Medicare cuts as much as 3 percent for each patient, although the average is generally much lower. The […]

  • CMS Launches ‘One-Stop Shop’ for States’ HCBS Investment Plans

    The U.S. Centers for Medicare & Medicaid Services (CMS) on Thursday launched a “one-stop shop” for state Medicaid agencies and in-home care stakeholders. The goal of the new digital tool is to “advance transparency and innovation” for home- and community-based services (HCBS), according to the agency. The one-stop shop specifically offers detailed information on how […]

  • CMS Hopes to Support Home-Based Care with More Payment, Regulatory Flexibilities

    Officials from the U.S. Centers for Medicare & Medicaid Services (CMS) and its main innovation hub touted a “strategy refresh” on Wednesday. Among its key pillars, the refresh calls for greater payment and regulatory flexibilities supporting the provision of home- and community-based care. CMS Administrator Chiquita Brooks-LaSure discussed the strategy reset during a Wednesday afternoon […]

  • Why Senior-Focused Primary Care Centers Are Reaching into the Home

    More and more primary care centers have chosen to specialize in serving seniors. In particular, companies such as CareMax Inc. (Nasdaq: CMAX), VillageMD and Humana Inc., mainly through its CenterWell Senior Primary Care arm, have all solidified their spots in the senior care sector by becoming a one-stop-shop for geriatric services. Sign up for HHCN […]

  • CMS suspends enrollment in UnitedHealthcare, Anthem MA plans

    The agency has suspended enrollment in three UnitedHealthcare plans and one Anthem plan for 2022 because the plans did not spend enough of their premium incomes on medical benefits and claims. The payers can contest the suspension, though it is unclear if they plan to.

  • Home Health Providers Seek Clarity on CMS Plan to Resume TPE Program

    As a response to the COVID-19 emergency, the U.S. Centers for Medicare & Medicaid Services (CMS) pressed pause on the targeted probe and educate (TPE) program in March 2020. A year later, CMS has plans to resume the program, according to an August 2021 MLNConnects newsletter. Broadly, TPE is a medical review program that began […]

  • How tech can help solve the overpayments problem in healthcare RCM

    When CMS overpays for services, providers and commercial payers are responsible for paying the agency back, and at times, they are on the hook for millions of dollars. But technology can help healthcare stakeholders catch the mistakes that lead to overpayments, thereby reducing unnecessary costs.

  • CMS to Require COVID-19 Vaccinations for Workers in ‘Most Health Care Settings’ — Including Home Health Care

    President Joe Biden unveiled a new six-pronged national COVID-19 strategy on Thursday, including stronger requirements around vaccinations for U.S. workers. Home health agencies were among the health care organizations explicitly mentioned in the plan. Along with either requiring or pushing American workers to get vaccinated, the Biden administration’s strategy calls for increased testing and masking […]

  • Home Health Industry Must Plan for Future PDGM Fight

    With a 1.7% bump to Medicare rates and seemingly few modifications to the Patient-Driven Groupings Model (PDGM), the home health proposed payment rule for calendar year 2022 felt relatively benign at first glance. In reality, though, the June 28 proposal from the U.S. Centers for Medicare & Medicaid Services (CMS) likely sets up a policy […]

  • CMS to fund 60 ACA navigator orgs next year

    CMS will provide $80 million to 60 organizations that train ACA navigators — who help consumers find coverage on the federally funded marketplaces — in the 2022 plan year, up from 30 organizations that received $10 million this year.

  • ‘Bring It On’: Home Health Executives Embrace HHVBP Expansion

    When the U.S. Centers for Medicare & Medicaid Services (CMS) first released its home health proposed payment rule for 2022, its nationwide expansion of the Home Health Value-Based Purchasing (HHVBP) Model was recognized as a potential game-changer for the home health industry. While HHVBP has been heralded for its ability to improve quality of care […]

  • HHCN+ Report: Breaking Down the Home Health Value-Based Purchasing Model

    The home health industry is once again in line for a major regulatory change. This time, it’s the looming expansion of the Home Health Value-Based Purchasing (HHVBP) Model, which has been active in nine demonstration states since 2016. As part of its most recent home health proposed payment rule, the U.S. Centers for Medicare & […]

  • After Pandemic Ravaged Nursing Homes, New State Laws Protect Residents

    When the coronavirus hit Martha Leland’s Connecticut nursing home last year, she and dozens of other residents contracted the disease while the facility was on lockdown. Twenty-eight residents died, including her roommate. “The impact of not having friends and family come in and see us for a year was totally devastating,” she said. “And then, […]

  • Biden’s No-Jab-No-Job Order Creates Quandary for Nursing Homes

    President Joe Biden’s edict that nursing homes must ensure their workers are vaccinated against covid-19 presents a challenge for an industry struggling to entice its lowest-paid workers to get shots without driving them to seek employment elsewhere. Although 83% of residents in the average nursing facility are vaccinated, only 61% of a home’s workers are […]

  • New Nursing Home Vaccine Requirements Could Trigger Staffing Scramble in Post-Acute Care

    The U.S. Centers for Medicare & Medicaid Services (CMS) announced a new emergency regulation Wednesday requiring staff COVID-19 vaccinations within all nursing homes reimbursed by Medicare and Medicaid. Up until now, health care providers in many states have been left to develop their own in-house vaccination policies for workers. In some instances, however, health care providers […]

  • CMS Officials Reflect on the Home Health Value-Based Purchasing Model’s Success

    Officials from the U.S. Centers for Medicare & Medicaid Services (CMS) are again touting the Home Health Value-Based Purchasing (HHVBP) Model as one of the agency’s most successful programs ever. In a Health Affairs article published Thursday, top CMS officials at CMS — including Administrator Chiquita Brooks-LaSure — looked back at a decade of alternative […]

  • Aveanna Applauds 2022 Proposed Payment Rule, Sets Sights on Home Health Growth

    In the wake of going public in the spring, the leadership team at Aveanna Healthcare Holdings Inc. (Nasdaq: AVAH) has been especially vocal about its appetite for major growth. The company’s leaders echoed this sentiment, highlighting a focus on home health in particular, during its Q2 2021 earnings call on Thursday. “Home health and hospice […]

  • Feds to Nix Work Requirements in Montana Medicaid Expansion Program

    Federal health officials will likely reject Montana’s request to include work requirements for beneficiaries of its Medicaid expansion program, which insures 100,000 low-income Montana adults, state officials said. Three years after the Trump administration encouraged states to require proof that adult enrollees are working a certain number of hours or looking for work as a […]

  • Community-Based Palliative Care, Choose Home Top List of Current Home Health Policy Priorities

    National Association for Home Care & Hospice (NAHC) President Bill Dombi touched on the importance of recent community-based palliative care legislation during a Sunday night policy update at the Washington, D.C.-based industry group’s 2021 Financial Management Conference. The bulk of his update, however, was spent urging industry insiders to band together and throw their support […]

  • 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 […]

  • 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 […]

  • CMS considers coverage of Biogen’s costly new Alzheimer’s drug

    CMS plans to review and determine coverage for Biogen’s Aduhelm, the first new Alzheimer’s disease treatment in decades. But the jury is still out on the drug’s effectiveness. Not to mention, its hefty price tag — $56,000 — could drive up Medicare spending.

  • 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 […]

  • 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 […]

  • 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 […]

  • ‘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 — […]

  • 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 […]

  • 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.

  • CMS nixes Medicaid work requirements in Arizona, Indiana

    After scrapping work requirements for Medicaid eligibility in four states, CMS has added Arizona and Indiana to the list. These requirements have long been controversial, facing litigation and strong opposition, but proponents say they incentivize people to find jobs.

  • 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, […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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, […]

  • 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 […]

  • 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 […]

  • 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 […]

  • CMS’ Next Generation ACO Model to end this year

    In a move that ACOs found “disappointing,” CMS has declined to extend the Next Generation ACO Model beyond 2021. Though evaluations have found that the model did not generate net savings for Medicare, proponents argue that the program was successful.

  • 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 […]

  • 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 […]

  • 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. […]

  • 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 […]

  • ‘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 […]

  • 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 […]

  • 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. […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • HHS issues HIPAA, CMS regulatory waivers to Texas hospitals

    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.

  • 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 […]

  • 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 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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, […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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 […]

  • 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, […]

  • 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, […]

  • 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 […]