NCQA

FEBRUARY 13, 2024

Potentially Harmful Drug-Disease Interactions in Older Adults : Assesses the rate in which Medicare members 65 years and older with certain high-risk diseases and/or conditions (history of falls, dementia, chronic kidney disease) are prescribed drugs that may have potentially harmful interactions with their existing condition. (ET)

Quality Assurance 52

Quality Assurance Hospitals Prevention Medicare 52

HIT Consultant

JANUARY 9, 2023

The Star Rating system, which measures the quality of care and member satisfaction in privately managed Medicare plans, helps consumers compare the benefits and costs of different plans. In December, the Centers for Medicare and Medicaid Services issued a proposal to include KED as a Star Rating.

Quality Assurance 52

Quality Assurance Medicare Medicaid Quality of Care 52

Sheppard Health Law

DECEMBER 3, 2021

On November 12, 2021, the Centers for Medicare and Medicaid Services (“CMS”) revised and finalized draft guidance first issued on May 3, 2019, for co-location of hospitals with other hospitals or healthcare providers [1] (the “ Finalized Guidance ”). The Finalized Guidance also makes significant changes to the guidelines for staffing.

Healthcare Providers 52

Healthcare Providers Quality Assurance Healthcare Hospitals 52

HIT Consultant

SEPTEMBER 7, 2022

Code is written by humans who have unconscious biases, and those biases can creep into the algorithms of AI when Quality Assurance functions are not properly sensitized to detect them. Bias remains a big concern in AI development and use.

Population Health 98

Population Health Health Analytics Quality Assurance Medicaid 98

Home Health Care

APRIL 28, 2023

Centers for Medicare & Medicaid Services (CMS) proposed a new rule that would make major changes to the way that home care workers are compensated under Medicaid. Aside from the 80% provision, the proposal also establishes a new strategy for oversight, monitoring, quality assurance and quality improvement for HCBS programs.

Medicaid 97

Medicaid Accountability Quality Assurance Home Care 97

Briggs Healthcare

JUNE 28, 2022

The HHVBP Newsletter provides home health agencies (HHAs) with the latest information about the expanded HHVBP Model as well as important tools, news, and timely insights from the Centers for Medicare & Medicaid Services (CMS) and the HHVBP Model Technical Assistance (TA) Team.

Quality Improvement 75

Quality Improvement Quality Assurance Medicare Performance improvement 75

NASHP

MARCH 14, 2022

For length-of-stay estimates, consider using the CMMI Medicare Choices Model of community-based pre-hospice services, with an average length of stay of 99 days. licensed hospice providers), with quality assurance provisions and any licensing updates necessary to ensure team competencies for non-hospice care.

Medicaid 94

Medicaid Rehabilitation Quality Assurance Patient Experience 94

Health Dialog

SEPTEMBER 17, 2018

The National Committee for Quality Assurance (NQCA) includes certified or evidence-based decision aids as an element of provider support in the most recent population health management accreditation standards.

Quality Assurance 40

Quality Assurance Population Health Patient Experience Medicaid 40

Home Health Care

APRIL 3, 2022

We know there is a lot of discussion around alternative payers, and many will ask, “Are you doing this to tap into Medicare Advantage programs?” By doing this, Home Instead franchise owners will have more time to dedicate to quality assurance visits, care plan assessment and relationship building with clients, families and their communities.

Home Care 122

Home Care Quality Assurance Integration Hospitals 122

HIT Consultant

JUNE 28, 2022

The National Committee for Quality Assurance (NCQA) has embarked on a major initiative to drive health equity by introducing race and ethnicity stratifications to its quality measures, beginning in the measurement year 2022. Here are four considerations for health plans on ways to become “data connectors” for health equity.

Quality Assurance 52

Quality Assurance Population Health Medicaid Hospitals 52

Etactics

MAY 11, 2023

First developed for the Medicare system, revenue codes were soon adopted as a standard for hospital billing as well as in other healthcare settings. Today, it is standard practice to outsource revenue cycle management operations , such as coding quality assurance systems.

Physical Therapy 52

Physical Therapy Urgent Care Quality Assurance Hospitals 52

NASHP

APRIL 17, 2023

In addition, starting in 2024, federal rules will require states to report performance on some measures, including some behavioral health measures, to the Centers for Medicare & Medicaid Services (CMS). It is often factored into plan payment, and it supports public reporting.

Medicaid 52

Medicaid Quality Assurance Quality Improvement Quality Review 52

NASHP

MARCH 29, 2024

Data Collection, Sharing, Use, and Quality Assurance The availability of robust, adequate, and equitable data is crucial for states to identify and address health disparities or barriers that result in limited or reduced access to high-quality and coordinated care for CYSHCN and their families. Telehealth.” Medicaid.gov.

Medicaid 124

Medicaid Quality of Care Quality Assurance Nursing 124

NASHP

DECEMBER 15, 2021

In recognition of this, the National Committee for Quality Assurance (NCQA) and the Penn Center for Community Health Workers developed standards for recruiting, employing, and supervising CHWs. Medicaid coverage of CHW services requires states to define the covered set of services, CHW qualifications, and reimbursement methodology.

Medicaid 52

Medicaid Accountable Care Accountability Quality Assurance 52

NASHP

AUGUST 24, 2023

State initiatives often require participating primary care practices to achieve National Committee for Quality Assurance PCMH recognition to access an enhanced (often PMPM) payment. States also frequently include additional requirements, such as specific staffing configurations, a focus on integrated care, and other clinical capacity.

Medicaid 52

Medicaid Quality Assurance Quality of Care Hospitals 52

NASHP

AUGUST 23, 2021

Lack of Access to Specialists Associated with Mortality and Preventable Hospitalizations of Rural Medicare Beneficiaries.” Maine has officially aligned this model with the Centers for Medicare and Medicaid Innovation’s Primary Care First initiative. iv] Johnston, K. Wen, and K. Joynt Maddox. Health Aff (Millwood) 38 (12): 1993-2002.

Primary Care 63

Primary Care Medicaid Accountability Quality Improvement 63

NASHP

MAY 8, 2023

Source: Centers for Medicare & Medicaid Services Health Disparities : Preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations. Centers for Medicare & Medicaid Services, 1998. Source: Cara James et al.,

Medicaid 52

Medicaid Regulations Prevention Medicare 52

Home Health Care

APRIL 13, 2022

Under the PHE, federal regulators have waived or modified normal requirements for Medicare and Medicaid providers, plus private health insurers. Medicare-certified home health agencies, in particular, have had access to a long list of waiver flexibilities. Instead, delayed submission is permitted during the PHE.

Quality Assurance 115

Quality Assurance Medicare Hospitals Medicaid 115