Healthcare IT Today

DECEMBER 24, 2024

As we wrap up another year and get ready for 2025 to begin, it is once again time for everyone’s favorite annual tradition of Health IT Predictions! Check out the community’s predictions down below and be sure to follow along as we share more 2025 Health IT Predictions ! From 2020 to 2050, the percentage of U.S.

Telemedicine 88

Telemedicine Medicaid Medicaid Doctors 88

Hall Render

FEBRUARY 17, 2025

According to a statement released on the Center for Medicare and Medicaid Services (CMS) website, effective February 14, 2025, implementation of the Hospice Special Focus Program for calendar year 2025 has ceased so that CMS may further evaluate the program. However, CMS noted that for one data source, only 49.3%

Medicare 89

Medicare Medicare Nursing Homes Medicaid 89

Healthcare IT Today

JANUARY 14, 2025

As we wrap up another year and get ready for 2025 to begin, it is once again time for everyone’s favorite annual tradition of Health IT Predictions! Check out the community’s predictions down below and be sure to follow along as we share more 2025 Health IT Predictions !

ACA 79

ACA Medicaid Medicaid Fraud 79

Fierce Healthcare

NOVEMBER 2, 2024

The Centers for Medicare and Medicaid Services (CMS) is moving forward with a 2.9% cut to physician payments in 2025 despite protest from major industry groups. | The Centers for Medicare and Medicaid Services (CMS) is moving forward with a 2.9%

Medicare 132

Medicare Medicare Doctors Medicaid 132

Fierce Healthcare

OCTOBER 10, 2024

Just 40% of Medicare Advantage prescription drug plans offered in 2025 achieved a score of four stars or higher, the Centers for Medicare & Medicaid Services (CMS) revealed Oct. It's harder than ever for Medicare Advantage plans to score well on star ratings. Here's how they performed for 2025.

Medicare 126

Medicare Medicare Medicaid Medicaid 126

Medisys Compliance

JANUARY 23, 2025

As we step into 2025, mental health providers must stay informed about evolving telehealth billing regulations to ensure compliance and optimize reimbursement. Will Medicare Stop Paying for Telehealth in 2025? What Is the CPT Code for Telehealth in 2025? CPT codes are essential for billing telehealth services accurately.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Medicare Medicare Medical Billing 59

HealthIT Answers

MARCH 11, 2025

This is notification that eligible hospitals and critical access hospitals participating in the Centers for Medicare & Medicaid Services Promoting Interoperability Program that there is an upcoming data submission deadline on March 14, 2025, at 11:59 p.m. Pacific Time.

Medicaid 59

Medicaid Medicaid Medicare Medicare 59

Bill of Health

NOVEMBER 12, 2024

Policy Solution #1: State Medicaid Expansion Expanding Medicaid in Alabama could bolster the finances of rural hospitals, which currently bear the substantial costs of uncompensated care for uninsured patients. However, Alabama’s political leadership remains resistant to Medicaid expansion. Senator Katie Britt (R-AL).

Medicaid 113

Medicaid Medicaid Hospitals Health Outcomes 113

Fierce Healthcare

SEPTEMBER 27, 2024

Medicare's open enrollment window opens in a few weeks, and the Centers for Medicare & Medicaid Services is offering a broad look at the landscape around Medicare Advantage and Part D before si | Medicare's open enrollment window opens in a few weeks, and the Centers for Medicare & Medicaid Services is offering a broad look at the (..)

Medicare 121

Medicare Medicare Medicaid Medicaid 121

Bill of Health

OCTOBER 17, 2024

This aligns with recent guidance from the Centers for Medicare and Medicaid Services that Medicare Advantage plans may not make a determination of medical necessity solely based on algorithms using broad data sets. 2025) research interests are focused on the intersection of health and the law. Rebekah Ninan’s (J.D.

Medicare 150

Medicare Medicare Health Insurance Licensing 150

Fierce Healthcare

APRIL 1, 2024

Insurers will feel resentful Monday as the feds opted to not reverse its decision to decrease Medicare Advantage benchmark payments by 0.16%, the Centers for Medicare and Medicaid announced. | CMS is not deviating from its January proposal to modestly rein in Medicare Advantage.

Medicare 143

Medicare Medicare Medicaid Medicaid 143

Fierce Healthcare

DECEMBER 17, 2024

The Centers for Medicare & Medicaid Services (CMS) is discontinuing the Medicare Advantage (MA) Value-Based Insurance Design model at the end of 2025. | The Value-Based Insurance Design model for Medicare Advantage plans will be terminated at the end of next year.

Medicare 126

Medicare Medicare Medicaid Medicaid 126

Mobi Health News

JULY 12, 2024

The proposed 2025 physician fee schedule from the Centers for Medicare & Medicaid Services includes payment and coding for digital health tools for behavioral health.

Medicaid 115

Medicaid Medicaid Medicare Medicare 115

Healthcare IT News - Telehealth

APRIL 22, 2024

Medicare was the first to cover RPM. Currently, it also is covered in some form by about 32 state Medicaid programs. It is also worth noting that Medicare is not necessarily required to update its coding rules to reflect AMA's CPT code rules. These have been the four most common general RPM codes for a few years now.

Medicare 194

Medicare Medicare Medicaid Medicaid 194

Healthcare IT Today

JANUARY 23, 2025

Shah, Co-Founder and CEO at Dina Payers Lean on Technology to Coordinate New Innovative Supplemental Benefits to Improve Quality, Outcomes, and Costs for Seniors Non-medical supplemental benefits like in-home support services, meal delivery, home modifications, and transportation have skyrocketed with Medicare Advantage (MA) plans.

Medicare 93

Medicare Medicare Medicaid Medicaid 93

Healthcare IT Today

DECEMBER 22, 2024

Access to home health for Medicare beneficiaries is decreasing , according to a recent report from Trella Health, with the number of home health visits per day down more than 17% between 2017 and 2023. O’Kane will retire at the end of 2025 ; she has led the organization for 35 years. People NCQA Founder and President Margaret E.

Medicare 84

Medicare Medicare FDA Telemedicine 84

HIT Consultant

DECEMBER 11, 2024

Food as Medicine: This trend has emerged from its niche, driven by increased funding and partnerships, particularly within Medicare Advantage and Medicaid programs. Looking Ahead to 2025 The digital health landscape is constantly evolving.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Jane Sarashon

DECEMBER 30, 2024

The 2025 convening of CES (once known as the Consumer Electronics Show) in Las Vegas officially kicks off on 7 January 2025. More granularly, Ill be looking into Sleep-tech: The square footage of CES convention floor space devoted to sleep has been significant and visible, with 2025 growing new products and sleep-tech flavors.

FDA 52

FDA Medicare Medicare Medical Billing 52

HIPAA Journal

MARCH 28, 2025

Two breach notices have been added to the Beacon Health System website, the first on March 24, 2025, involving a business associate called CPS Solutions, a provider of services to support pharmacy operations. Notification letters were mailed to the affected individuals on February 10, 2025.

Licensing 61

Licensing Health Insurance HIPAA Medicaid 61

Fierce Healthcare

OCTOBER 21, 2024

Humana, one the country’s largest Medicare Advantage organizations, is suing the Centers for Medicare & Medicaid Services over its 2025 star | Humana, one the country’s largest Medicare Advantage organizations, is suing the Centers for Medicare & Medicaid Services over its 2025 star ratings results.

Medicaid 116

Medicaid Medicaid Medicare Medicare 116

Verisys

FEBRUARY 10, 2025

What You Need to Know: The National Committee for Quality Assurance (NCQA) has announced significant updates to its credentialing and monitoring requirements, effective July 1, 2025. Key NCQA 2025 Compliance Changes 1. The post Navigating NCQAs 2025 Credentialing & Monitoring Requirements appeared first on Verisys.

Licensing 40

Licensing Compliance Medicaid Medicaid 40

Healthcare IT Today

JANUARY 22, 2025

Here’s a quick look at some of the health IT jobs we found: Systems Analyst 1- EMR and Clinical Workflows – Oracle Manager Data Health Informatics – MLK Community Healthcare Director, Software Engineering – Midi Health Business Office Representative Clerk – Owensboro Surgery Center – SCA Health Behavioral Health (..)

Due Diligence 64

Due Diligence Medicaid Medicaid Medicare 64

Fierce Healthcare

NOVEMBER 25, 2024

UnitedHealthcare successfully won its lawsuit over the Centers for Medicare and Medicaid Services, a federal judge determined Nov. UnitedHealthcare will get to claim victory over CMS for its star ratings lawsuit win.

Medicaid 119

Medicaid Medicaid Medicare Medicare 119

Fierce Healthcare

JULY 10, 2024

A proposed rule outlining the Centers for Medicare & Medicaid Services’ (CMS’) intended Medicare payment rates and policy updates for outpatient and ambulatory surgical centers (ASCs) in the co | The administration's CY 2025 OPPS and ASC Payment Systems proposed rule looks to improve obstetrical services, quality reporting and care access. (..)

Payment Systems 124

Payment Systems Medicare Medicare Medicaid 124

Hall Render

MARCH 10, 2025

On March 7, 2025, the Centers for Medicare & Medicaid Services (CMS) posted a memo dated March 10, 2025, that gives nursing homes and surveyors more time to prepare for implementation of new rules and updates to allow surveyors to add extra attention and increase oversight in nursing homes.

Nursing Homes 52

Nursing Homes Nurses Medicaid Medicaid 52

Hall Render

MARCH 27, 2025

The Centers for Medicare & Medicaid Services (CMS) has given surveyors additional rules and updates to allow surveyors to assess and cite violations of the regulations on nursing homes with admission agreements that create prohibited third-party guarantee of resident payments.

Nursing Homes 52

Nursing Homes Nurses Medicaid Medicaid 52

Fierce Healthcare

JULY 11, 2024

The Centers for Medicare & Medicaid Services' (CMS') proposed calendar year 2025 physician fee schedule rule, out Wednesday, proposed an assortment of new payments and coverage for digital heal | CMS' proposed changes to digital health payment for physicians includes new codes for mental health-related digital therapeutics, an assortment (..)

Medicaid 129

Medicaid Medicaid Medicare Medicare 129

Healthcare IT News - Telehealth

AUGUST 29, 2024

The American Telemedicine Association and ATA Action in a letter to the Centers for Medicare and Medicaid Services seeks to preserve pandemic-era Medicare telehealth flexibilities that it says are responsible for improving access to healthcare across the U.S. Permit access virtual cardiac and pulmonary rehabilitation services.

Medicare 150

Medicare Medicare Medicaid Medicaid 150

AIHC

MARCH 31, 2025

The "Sunshine Act," officially known as the Physician Payments Sunshine Act, mandates those manufacturers of drugs, medical devices, and biologics report payments and transfers of value to physicians and teaching hospitals to the Centers for Medicare & Medicaid Services (CMS).

Compliance 64

Compliance COVID-19 Compliance Officers Medicaid 64

HealthIT Answers

JANUARY 16, 2025

The Centers for Medicare & Medicaid Services has posted new 2025 Merit-based Incentive Payment System (MIPS) resources to the QPP Resource Library. The post Now Available: 2025 MIPS Resources appeared first on Health IT Answers.

Payment Systems 59

Payment Systems Medicaid Medicaid Medicare 59

Fierce Healthcare

APRIL 2, 2024

States now can add routine adult dental services as an essential health benefit, the Centers for Medicare & Medicaid Services announced in its 2025 Notice of Benefit and Payment Parameters fina | In its annual Notice of Benefit and Payment Parameters final rule, CMS prioritized dental and prescription drug benefits, network adequacy standardization (..)

ACA 110

ACA Medicaid Medicaid Medicare 110

Health Law Advisor

FEBRUARY 2, 2023

On February 1, 2023, the Centers for Medicare & Medicaid Services (CMS) published a final rule outlining its audit methodology and related policies for its Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program. million per year starting in 2025 for PY 2018 from extrapolated recoveries.

Medicare 98

Medicare Medicare Overpayments Overpayment 98

HIT Consultant

JULY 15, 2024

– The Centers for Medicare & Medicaid Services (CMS) released a proposed rule outlining changes to Medicare payments under the Physician Fee Schedule (PFS) for services furnished and other Medicare Part B issues on or after January 1, 2025.

Medicare 52

Medicare Medicare Payment Systems Medicaid 52

Fierce Healthcare

AUGUST 21, 2023

The Centers for Medicare & Medicaid Services (CMS) released new draft guidance Monday on how it plans to roll out a program that allows Medicare members to spread out monthly payments for presc | New draft guidance gives a blueprint for pharmacies to begin offering monthly payments on prescription drugs starting in 2025.

Medicare 98

Medicare Medicare Medicaid Medicaid 98

Innovaare Compliance

JUNE 28, 2024

The upcoming Medicare Prescription Payment Plan (M3P), set to launch in January 2025, marks a significant shift in Medicare’s approach to prescription drug coverage. Understanding the Medicare Prescription Payment Plan M3P introduces a novel approach to managing prescription drug costs for Medicare beneficiaries.

Medicare 94

Medicare Medicare Prescription Drug Pricing Compliance 94

Innovaare Compliance

FEBRUARY 25, 2024

The Centers for Medicare & Medicaid Services (CMS) uses the Hierarchical Condition Category (CMS-HCC) medicare risk adjustment model to determine monthly capitation fees for Medicare Advantage (MA) plans. The coverage gap will be eliminated in 2025, and manufacturers’ discounts will begin in ICL.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Innovaare Compliance

JUNE 30, 2024

The Centers for Medicare & Medicaid Services (CMS) provides standardized model materials to facilitate the process. Notable changes related to Part D Re-design and regulations in the final rule are highlighted below: Part D Coverage Gap is removed in CY 2025, as all references should be (e.g., Section 2.1 and Section 3.2,

Medicare 52

Medicare Medicare Compliance Medicaid 52