Triage Health Law

JULY 27, 2023

On May 10, 2023, the Center for Medicare & Medicare Services (“CMS”) issued guidance to clarify the definition of “marketing” for Medicare Advantage Plans (“MA Plans”) and Prescription Drug Plans (“PDPs”). [1] As a result, CMS decided to expand the “marketing” definition to prevent misleading marketing practices.

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Medicare Regulations Medicaid Prevention 98

HIT Consultant

DECEMBER 8, 2023

Such advancements stand to revolutionize how healthcare entities treat, prevent, and better understand this nuanced condition. Expanding Treatment Today, CKD patients benefit from an array of ambitious treatment, preventive care, and risk management options – most of which stem from breakthroughs in related technologies.

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Prevention Healthcare Providers Medicare Healthcare 98

Fierce Healthcare

DECEMBER 18, 2023

Legal experts indicated they will be paying close attention to lawsuits surrounding the Medicare drug price negotiation program and Braidwood v. Preventative services covered under the Affordable Care Act and the Medicare drug price negotiations program are two legal questions that will play out next year.

Medicare 285

Medicare Prevention 285

HIT Consultant

FEBRUARY 12, 2024

What You Should Know: – Medicare has significantly expanded access to the Eversense E3 continuous glucose monitoring (CGM) System, a long-lasting and implantable option that offers several advantages over traditional CGMs. Predictive on-body alerts to help prevent critical events, especially during sleep or when away from a phone.

Medicare 98

Medicare Prevention 98

HIT Consultant

SEPTEMBER 12, 2023

The company plans to utilize the capital to support Bold’s continued expansion with national and regional Medicare plans and provider groups, and accelerate the growth of its clinical exercise offerings to support the diverse physical and mental health needs of older adults. The latest funding, bringing its total amount raised to $27M.

Medicare 116

Medicare Prevention 116

Home Health Care

JUNE 30, 2023

Centers for Medicare & Medicaid Services (CMS) published a draft of its FY 2024 home health proposed payment rule Friday. It would also force The Medicare Payment Advisory Commission (MedPAC) to consider Medicare Advantage (MA) payment rates in its reports. “We This is a developing story. The post CMS Proposes 2.2%

Medicare 128

Medicare Medicaid Home Care Prevention 128

HIT Consultant

JANUARY 25, 2024

What You Should Know: The Ohio State University Wexner Medical Center a nd CVS Accountable Care, part of CVS Health® (NYSE: CVS), today announced the creation of an accountable care organization (ACO) to improve the quality of care for Medicare beneficiaries by Ohio State providers in central Ohio.

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Medicare Accountable Care Accountability Quality of Care 90

Home Health Care

OCTOBER 23, 2023

Insurance companies selling Medicare Advantage (MA) plans have been facing increased scrutiny from members of Congress and regulators, with critics of the private version of Medicare claiming carriers are profiting far too much. There was a 364% increase in plans offering the benefit since 2020. The agency is implementing a 3.3%

Medicare 111

Medicare Home Care Primary Care Regulations 111

HIT Consultant

SEPTEMBER 1, 2021

– The Bold platform is one of five interventions in the Ochsner Connected Stability pilot fall prevention and monitoring programs focused on helping Medicare Advantage members who are at the highest risk for falls. For non-fatal falls alone, $29 billion was paid out by Medicare in 2018 for treatment and care.

Prevention 52

Prevention Medicare Healthcare 52

Briggs Healthcare

AUGUST 20, 2021

See updated information in this Medicare Learning Network (MLN) web-based training course: How to identify and report Provisions and penalties Prevention methods. Mary Madison, RN, RAC-CT, CDP Clinical Consultant – Briggs Healthcare.

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Prevention Medicare Healthcare 52

Briggs Healthcare

JULY 6, 2022

On September 30, 2019, the Centers for Medicare & Medicaid Services (CMS) published the final rule Medicare and Medicaid Programs; Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction Final Rule , which included revisions for the hospital Conditions of Participation (CoP) for 42 CFR §482.42

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Prevention Hospitals Regulations Medicaid 98

HIT Consultant

APRIL 16, 2024

What You Should Know: – inVio Health Network and CVS Accountable Care Organization, a division of CVS Health , have announced a collaboration to participate in the new Medicare Accountable Care Organization (ACO) REACH program.

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HIT Consultant

MARCH 11, 2024

What You Should Know: – Nearly 70% of Medicare patients would be comfortable doing annual wellness visits (AWVs) via telehealth from home, according to the results of a consumer survey by KeyCare , an Epic-based virtual care company. This shift could significantly improve access to preventive care for a growing population.

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Medicare Doctors Prevention Healthcare Providers 52

Fierce Healthcare

AUGUST 29, 2023

CMS released its highly anticipated list of 10 drugs subject to Medicare price negotiations Tuesday, which includes popular blood clot prevention drugs Eliquis and Xarelto and diabetes drugs Jardia | CMS released its highly anticipated list of 10 drugs subject to Medicare price negotiations Tuesday, a big first step in pushing back against the pharmaceutical (..)

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Pharmaceuticals Medicare Prevention 246

Home Health Care

APRIL 21, 2023

The Expanding Care in the Home Act (ECHA) would, among other things, create a personal care services benefit in Medicare to give aid to beneficiaries who are unable to afford out-of-pocket payments but don’t qualify for home care services by Medicaid. In theory, that would reduce additional Medicare spending.

Medicare 98

Medicare Home Care Medicaid Prevention 98

HIT Consultant

OCTOBER 24, 2023

What You Should Know: – UnitedHealthcare and RUSH Health announced a new relationship that will give UnitedHealthcare Medicare Advantage plan members network access to all RUSH Health locations in Illinois for the first time, effective immediately. – The multi-year agreement, effective Oct.

Medicare 52

Medicare Prevention Hospitals Integration 52

Home Health Care

JUNE 29, 2022

House lawmakers are pushing for more oversight of Medicare Advantage (MA) plans in light of concerns over higher spending, improper claim denials and access to treatment. Improper claim denials and increased use of prior authorizations are preventing beneficiaries from receiving the care they need.”. Medicare,” she said.

Medicare 97

Medicare Prevention Accountability Medicaid 97

Home Health Care

NOVEMBER 18, 2021

In-home support services are the most popular — and arguably impactful — supplemental benefit offered by Medicare Advantage (MA) plans under the primarily health-related category. Centers for Medicare & Medicaid Services (CMS) made supplemental benefits like in-home care allowable in 2018 for the 2019 plan year.

Medicare 124

Medicare Home Care Medicaid Prevention 124

Home Health Care

AUGUST 30, 2021

CommonSpirit Health carved out $136 million in savings to Medicare for 2020, while also improving overall outcomes for hundreds of thousands of beneficiaries, the company recently announced. CommonSpirit Health is a participant in the Medicare Shared Savings Program (MSSP), which began back in 2012 after being designed by the U.S.

Medicare 116

Medicare Rehabilitation Home Care Accountable Care 116

Health Populi

JUNE 27, 2022

Declines in preventive care services like cancer screenings and blood glucose testing concern employers, whose continued to cover health insurance for employees during the pandemic. The full report speaks to medical spending and utilization trends for preventive care, telehealth, and behavioral health.

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Prevention Primary Care Medicaid Medical Services 121

Home Health Care

JULY 24, 2022

Along with achieving better health outcomes, Medicare Advantage (MA) checks in at annual consumer savings of roughly $2,000. That’s according to a new report from the research and advocacy organization Better Medicare Alliance (BMA). million beneficiaries, or 45% of the Medicare population. Source: Better Medicare Alliance.

Medicare 98

Medicare Hospitals Home Care Prevention 98

Fierce Healthcare

JULY 17, 2023

Major industry groups have roundly called for Congress to step in to prevent the Medicare reimbursement changes from going through. The Biden administration is proposing cuts to physician payments | The Biden administration is proposing cuts to physician payments in its annual fee schedule, and doctors are not happy.

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Home Health Care

DECEMBER 5, 2021

Among its home- and community-based care initiatives, Aetna is doubling down on the use of telehealth and leaning into the CVS HealthHUB network, which offers seniors a range of services, from preventative care all the way to acute care. million Medicare members nationwide. I think it’s important to focus on aging in place.”.

Medicare 124

Medicare Urgent Care Nursing Hospitals 124

Home Health Care

OCTOBER 4, 2022

With the annual enrollment period just around the corner, Medicare Advantage (MA) organizations are starting to tout what benefits they’re offering seniors for the upcoming year. MA is a form of Medicare that is administered by private insurers. Medicare open enrollment runs from October 15 to December 7, 2022. Humana Inc.

Medicare 105

Medicare Primary Care Urgent Care Home Care 105

Home Health Care

JULY 28, 2022

Centers for Medicare & Medicaid Services (CMS) released its proposal for home health care last month. On the legislative side, Amedisys had been in discussions with congressional members regarding a plan to prevent CMS from instituting the proposed cuts for months. Medicare Advantage strategy.

Medicare 98

Medicare Medicaid Hospitals Prevention 98

Briggs Healthcare

JULY 6, 2023

In the letter to Congress, APIC strongly recommends: Each nursing home should have at least one full-time infection preventionist on staff who is dedicated (meaning that infection prevention is their sole function), not the current requirement of having a staff member designated to handle infection prevention. Arlington, Va.,

Prevention 40

Prevention Nursing Patient Safety Quality of Care 40

Home Health Care

AUGUST 4, 2023

Here is a look at three steps providers can take to improve their QAPI approach, fix their VBP scores and boost their Medicare payments. You kind of have to think outside of the box of making a visit, making a visit, making a visit, and instead making meaningful contact with the patient to try to prevent the problem,” she says.

Medicare 98

Medicare Performance improvement Quality Assurance Quality Improvement 98

Briggs Healthcare

FEBRUARY 10, 2023

Mary Madison, RN, RAC-CT, CDP Clinical Consultant – Briggs Healthcare The American Health Care Association (AHCA) has partnered with the Association for Professionals in Infection Control and Epidemiology (APIC) to set up a national forum for infection preventionists and infection prevention champions working in long term care (LTC).The

Prevention 40

Prevention Medicaid Medicare Healthcare 40

Etactics

JUNE 29, 2023

And those who work with the elderly and disabled in a nursing home setting will likely find themselves working with Medicare. While Medicare may not fully cover a stay in a nursing home, depending on an individual's circumstances, they can still qualify for partial coverage. Medicare coverage depends on: State and federal laws.

Nursing 52

Nursing Medicare Home Care Medicaid 52

Briggs Healthcare

AUGUST 2, 2022

“Selected nursing homes may not have complied with Federal requirements for infection prevention and control and emergency preparedness. Specifically, 28 of the 39 nursing homes had possible deficiencies. This is the opening statement for brief of the OIG Report published July 26, 2022. “(OIG)

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Healthcare It News

NOVEMBER 29, 2023

million in savings across multiple Medicare and Medicare Advantage plans, according to an announcement Wednesday. Automated pre-visit planning helped prevent downstream utilization, such as inpatient visits, while helping to deliver more comprehensive patient care.

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Medicare Population Health Patient Experience Nursing 207

Briggs Healthcare

JUNE 7, 2023

Mary Madison, RN, RAC-CT, CDP Clinical Consultant – Briggs Healthcare The Q4FY22 release of the Hospice Program for Evaluating Payment Patterns Electronic Report (PEPPER) , which was distributed on April 5, 2023, included two new target areas that provide the average number of Medicare Part B claims paid during hospice episodes.

Medicare 40

Medicare Nursing Prevention Healthcare 40

Briggs Healthcare

MARCH 22, 2023

This report: (1) describes actions experts identified that HHS should continue, enhance, or discontinue to improve infection prevention and control practices in nursing homes and (2) compares actions identified by experts with prior recommendations from GAO and others.

Prevention 52

Prevention Nursing Quality of Care Medicaid 52

Home Health Care

APRIL 12, 2024

In past years, Medicare-certified home health agencies and Medicaid personal care services providers have been big focus areas for government watchdogs. Centers for Medicare & Medicaid Services (CMS) data. Medicare’s acute- and post-acute-care transfer policies are yet another focus area for OIG. billion in claims.

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Medicaid Medicare Home Care Regulations 100

Health Care Dive

SEPTEMBER 10, 2021

CMS and the Centers for Disease Control and Prevention are requiring that all provider facilities that participate in the Medicare and Medicaid programs vaccinate their workers, according to a Thursday release.

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Medicaid Prevention Medicare Healthcare 245

Healthcare ECONOMIST

MARCH 7, 2022

To measure how these capabilities impacted Medicare spending, the authors linked the NSHOS responses with 2017 Medicare beneficiary fee-for-service claims data based on physicians’ Taxpayer Identification Numbers (TIN). Capabilities were then rescaled to range between 0 and 1. billion could be saved annually.

Medicare 60

Medicare Quality of Care Prevention Hospitals 60

Sheppard Health Law

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).

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Medicare Rehabilitation Urgent Care Patient Safety 52