HIT Consultant

OCTOBER 13, 2022

Medicare Advantage Plan for LGBTQ+ Older Adults. There is a growing number of LGBTQ+ adults over age 50, with the number expected to reach 7 million by 2030. – SCAN Health Plan will offer the SCAN Affirm plan to members in California’s Los Angeles and Riverside Counties.

Medicare 98

Medicare Medicare 98

MRO Compliance

JULY 12, 2023

Accurate, properly documented, interoperable patient data is required to achieve CMS’s goal for 100 percent of Medicare (and the majority of Medicaid) beneficiaries to be enrolled in some type of accountable, or value-based, care arrangement by 2030.

Medicaid 130

Medicaid Medicaid Medicare Medicare 130

MedTrainer

APRIL 18, 2024

Behavioral health credentialing exploded in 2023 and 2024 as providers could enroll in Medicare for the first time. Download Now Common Challenges in Behavioral Health Credentialing Where behavioral health credentialing diverges from typical provider credentialing is Medicare enrollment.

Medicare 52

Medicare Medicare Licensing Compliance 52

HIT Consultant

JANUARY 18, 2023

– Reimbursable through Medicare and many commercial plans, Ornish Lifestyle Medicine by Sharecare is the first and only ICR program scientifically proven in randomized controlled trials to often reverse the progression of coronary heart disease and many other chronic conditions, without drugs or surgery.

Medicare 98

Medicare Medicare Nurses 98

Hall Render

NOVEMBER 29, 2023

On November 2, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued the 2024 Medicare Physician Fee Schedule Final Rule (“Final Rule”) for calendar year (“CY”) 2024. Standards for benchmarking and data completeness for the Medicare CQM collection type will mirror the MIPS benchmarking and scoring policies.

Medicare 40

Medicare Medicare Nurses Payment Systems 40

Healthcare IT Today

OCTOBER 3, 2024

As CMS targets having all Traditional Medicare beneficiaries and most Medicaid beneficiaries in accountable care relationships by 2030, there is an urgent need for healthcare providers, particularly those serving the 65+ demographic, to adopt value-based approaches. .

Medicare 111

Medicare Medicare Medicaid Medicaid 111

HealthIT Answers

SEPTEMBER 25, 2023

By Aisha Pittman MPH & Clif Gaus ScD - NAACOS has been advocating for several changes to the Medicare Shared Savings Program. The post NAACOS Largely Supports Proposed Changes to Medicare’s Largest ACO Program appeared first on Health IT Answers.

Medicare 64

Medicare Medicare 64

Hall Render

AUGUST 6, 2024

The Centers for Medicare & Medicaid Services (“CMS”) released the 2025 Inpatient Prospective Payment System (“IPPS”) Final Rule (“Final Rule”) on August 1, 2024. Background on Rural and Urban Delineations Medicare classifies hospitals by rural and urban status for a variety of payment purposes.

Medicare 40

Medicare Medicare Payment Systems Hospitals 40

Hall Render

AUGUST 6, 2024

The Centers for Medicare & Medicaid Services (“CMS”) released the 2025 Inpatient Prospective Payment System (“IPPS”) Final Rule (“Final Rule”) on August 1, 2024. Background on Rural and Urban Delineations Medicare classifies hospitals by rural and urban status for a variety of payment purposes.

Medicare 40

Medicare Medicare Payment Systems Hospitals 40

Hall Render

MAY 23, 2023

The Centers for Medicare & Medicaid Services (“CMS”) is now accepting applications from ACOs to participate in the Medicare Shared Savings Program (“MSSP” or “Program”) for the agreement period beginning January 1, 2024. The application process is split into two phases.

Medicare 64

Medicare Medicare Medicaid Medicaid 64

Healthcare Law Blog

MAY 5, 2022

Department of Health and Human Services Office of Inspector (“OIG”) released a report that studied prior authorization denials and payment denials by Medicare Advantage Organizations (“MAOs”) (the “Report”). Thirteen percent of denied prior authorization requests met Medicare coverage rules. The OIG Report. additional test results).

Medicare 52

Medicare Medicare Licensing Health Insurance 52

Hall Render

MARCH 21, 2024

The Centers for Medicare & Medicaid Services (“CMS”) recently announced the ACO Primary Care Flex Model (“Flex Model”), a new voluntary model within MSSP for low-revenue ACOs, that begins January 1, 2025.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

HealthIT Answers

NOVEMBER 28, 2022

By Liz Fowler JD PhD, Purva Rawal PhD, Sarah Fogler PhD, Brian Waldersen MD MPH, Meghan O’Connell MPH, & Jacob Quinton MD MSHS - In 2021, CMS established a goal to have 100 percent of Original Medicare beneficiaries and the vast majority of Medicaid beneficiaries in accountable care relationships by 2030,,, The post The CMS Innovation Center’s (..)

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

HIT Consultant

FEBRUARY 6, 2024

These FQHCs will participate in two key CMS value-based care programs: ACO REACH and MSSP (Medicare Shared Savings Program). The participating ACOs will collectively cover nearly 50,000 Medicare lives, significantly expanding access to value-based care for underserved communities.

Medicare 52

Medicare Medicare 52

Jane Sarashon

MAY 30, 2024

But to keep building on models for staying at home as we age will require policy changes for public sector programs, such as Medicare and Medicaid, as well as commercial/private sector programs that can support people in aging in novel ways not yet served up in the private sector.

Medicare 75

Medicare Medicare Licensing Hospitals 75

HIT Consultant

SEPTEMBER 16, 2024

According to the Centers for Medicare & Medicaid Services , annual growth in national health spending is expected to average 5.1% from 2021-2030, reaching nearly $6.8 trillion by 2030. This process is highly inefficient, and this workload is going to worsen as demand increases. healthcare spending reached $4.5

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

HIT Consultant

NOVEMBER 16, 2022

People over 85 are the most rapidly expanding demographic and the elderly segment of the American population is expected to double in 2030 from 2010. By 2030, we are projected to have less than 7,300 geriatricians nationwide. The total number of Board Certified Geriatricians in the U.S.

Nurses 52

Nurses Telemedicine Patient Satisfaction Medicare 52

Medisys Compliance

JULY 27, 2022

CMS is planning to gradually reduce this coinsurance until it’s completely free for dates of service on or after January 1, 2030. For dates of service on or after calendar year 2030, Medicare waives the coinsurance. For dates of service calendar years 2027-2029, the reduced coinsurance is 10%.

Medical Billing 52

Medical Billing Medical Billing Outsourcing ACA Medicare 52

Healthcare IT News - Telehealth

DECEMBER 14, 2021

Caravan Health President and CEO Tim Gronniger previously was chief of staff and director of delivery system reform at the Centers for Medicare and Medicaid Services. In 2019 and 2020, its partners earned $300 million in Medicare savings, more than $120 million in shared savings, and quality scores exceeding 97%, the company reported.

Medicare 183

Medicare Medicare COVID-19 Telemedicine 183

Healthcare IT Today

MAY 21, 2024

They’re goal is to have 100% of Medicare beneficiaries in a value-based care arrangement by 2030. We see a number of ACO approaches that make up these efforts, along with Medicare Advantage plans. The following is a guest article by Phyllis Wojtusik, Executive Vice President of Value-Based Care at Real Time Medical Systems.

Medicare 132

Medicare Medicare Hospitals Nurses 132

Jane Sarashon

JUNE 10, 2024

I’ll be leading 2 panels covering the huge and growing challenge of trust in health care, and then the future of the health consumer looking to 2030, as well as doing a book signing for my look at HealthConsuming: From Health Consumer to Health Citizen , addressing growing consumerization in health care.

Health Insurance 59

Health Insurance Ransomware Hospitals Nurses 59

Hall Render

NOVEMBER 20, 2023

On November 17, 2023, CMS published its final rule requiring Medicare and Medicaid nursing facilities to provide more detailed ownership and managerial information. The final rule includes new definitions of “private equity company” and “real estate investment trust” for Medicare enrollment purposes. HCA plans to invest $5.3B

Nurses 40

Nurses Medicare Medicare Medicaid 40

Health Populi

JULY 13, 2020

economic outlook for 2020 to 2030 on July 1, 2020. For health care, the data portrayed in the next chart will be concerning: the Medicare and Social Security Trust Funds are expected to hit “zero” (the X-access) by 2025 and just after 2030, respectively. The Congressional Budget Office published an update to the U.S.

COVID-19 110

COVID-19 Medicare Medicare Hospitals 110

HIT Consultant

FEBRUARY 10, 2022

This focus also supports critical imperatives from the Centers for Medicare & Medicaid Services (CMS) to improve health equity and have everyone in Medicare fee-for-service aligned to an accountable relationship by 2030,” said Kyle Armbrester, CEO of Signify Health. “We

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Hall Render

APRIL 12, 2024

On April 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) released the 2025 Inpatient Prospective Payment System (“IPPS”) Proposed Rule (“Proposed Rule”). Hospitals and stakeholders should review whether they are in a county affected by the updated delineations and assess any potential impact on Medicare reimbursements.

Medicare 40

Medicare Medicare Payment Systems Hospitals 40

Healthcare IT Today

JULY 18, 2024

CareJourney derives market-leading analytics from Medicare, Medicaid, Medicare Advantage, and Commercial claims data across more than 300 million beneficiaries and over 2 million providers nationwide. Payers, providers, and employers can use these actionable insights to accelerate growth and improve performance. .”

Medicare 73

Medicare Medicare Governance Medicaid 73

HIT Consultant

JUNE 8, 2023

However, insufficient technology to implement value-based care models, a hesitancy to accept financial risk, opposing incentives and no established contract blueprint remain key barriers to adoption.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Healthcare IT News - Telehealth

JANUARY 23, 2024

Because of the lag in diagnosis, clinical research has shown that 65% of Medicare patients are first diagnosed with heart failure in the ER or inpatient setting, and this the number increases to 75% for patients with lower socioeconomic status. healthcare expenditures by 2030. Heart failure will account for $70 billion of U.S.

FDA 161

FDA Hospitals Medicare Medicare 161

HIPAA & Health IT

MAY 19, 2023

Ideally, this will manifest in increased interoperability capabilities nationwide—the Centers for Medicare & Medicaid Services has committed to transitioning to value-based arrangements by 2030.

Nursing Homes 52

Nursing Homes Nurses Public Health Medicaid 52

HIPAA & Health IT

MAY 19, 2023

Ideally, this will manifest in increased interoperability capabilities nationwide—the Centers for Medicare & Medicaid Services has committed to transitioning to value-based arrangements by 2030.

Nursing Homes 52

Nursing Homes Nurses Public Health Medicaid 52

Healthcare Law Blog

DECEMBER 12, 2022

The Centers for Medicare & Medicaid Services (CMS) Innovation Center continues to move forward with its “strategic refresh” initiative. Through this shift, CMS aims to examine and enhance payments for specialty care provided to Medicare beneficiaries. Value-Based Care and ACOs.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

HIT Consultant

APRIL 3, 2023

These risk-based care models are designed to encourage proactive care, better population health and reduced spending across the healthcare spectrum.

Medicaid 98

Medicaid Medicaid Medicare Medicare 98

Healthcare IT Today

MARCH 27, 2023

billion by 2030, according to Research and Markets Reports. New Payer Coverage and Revenue Cycle Management With 250 million patient lives covered under 600+ of the nation’s top payers, including Medicare, Medicaid and every major private insurer, OpenLoop is also announcing today a new Payer Coverage & RCM service.

Licensing 107

Licensing Health Outcomes Medicaid Medicaid 107

Medisys Compliance

APRIL 18, 2022

In October 2021, the Center for Medicare and Medicaid Innovation (CMMI) announced a goal of having every Medicare beneficiary and the majority of Medicaid beneficiaries covered by some type of alternative payment model (APM) by 2030. In order to do so, a clinician must be in a Medicare Advanced APM.

Medical Billing 52

Medical Billing Medical Billing Outsourcing Medicaid Medicaid 52

MedTrainer

MARCH 8, 2024

These financial incentives are from agencies such as the Centers for Medicare and Medicaid Services (CMS) and the Health Resource & Services Administration (HRSA) , who are working to achieve health equity and improve public health. FQHCs can participate in APMs through Medicare and Medicaid Managed Care Organizations (MCOs).

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

HIT Consultant

FEBRUARY 8, 2024

The Centers for Medicare and Medicaid Services (CMS) intends to shift traditional Medicare and many Medicaid beneficiaries into VBC arrangements by 2030. Value-based contracting rapidly evolves, with federal and state regulatory bodies imposing new mandates.

Medicaid 105

Medicaid Medicaid Medicare Medicare 105

Hall Render

MAY 10, 2024

On April 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) announced its plan to implement the Transforming Episode Accountability Model (“TEAM”), a new mandatory alternative payment model unveiled as part of the 2025 Hospital Inpatient Prospective Payment System proposed rule.

Medicare 40

Medicare Medicare Hospitals Medicaid 40