Discover answers to key questions about the CMS Final Rule 0057-F for payers & providers. Stay compliant and informed with BHM Healthcare Solutions. #payers #providers #compliance Centers for Medicare & Medicaid Services https://lnkd.in/gTEPDfVU
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Succeeding in at-risk alternative payment models requires cost transparency awareness at the point of specialist care initiation and subsequent post acute care management. That knowledge translates to narrower spend variations in episode-of-care delivery within patient populations matched by disease severity. BPCI can prove to be a significant first step engagement in at risk contacting prior to the proposed CMS mandatory episodes and value-based referrals impacting specialist group practices in the coming years.
💡Value-Based Care Fact: The Bundled Payments for Care Improvement (BPCI) Advanced Model saved $465 million in Medicare spending in 2021, according to the Centers for Medicare & Medicaid Services. Supporting alternative payment models like the BPCI Advanced Model is key to improving patient care while reducing Medicare spending. More from JD Supra: https://bit.ly/3yZ516h #APM #ValueBasedCare #Medicare
CMS Releases Fifth Annual Report on Bundled Payments for Care Improvement Advanced Model
https://www.jdsupra.com/
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Founder @ Total Healthcare Billing | Business Ownership, Medical Billing, Healthcare Consulting, Revenue Cycle Management, Practice Management Workflows
🌟 EXCITING NEWS FOR PHYSICIANS! 🌟 In light of recent challenges faced due to the cyber-attack on Change Healthcare, the Centers for Medicare and Medicaid Services (CMS) is stepping in with a lifeline for impacted physicians! 🚑💻 CMS has announced a NEW OPPORTUNITY for physicians to request advance Medicare payments. This initiative is aimed at alleviating cash flow disruptions and ensuring that healthcare services continue smoothly. 💡💸 Don't let financial hurdles slow down your invaluable services. Check out the full details of the program, understand the terms, and learn how to apply through the links provided below. Seize this chance to stabilize your practice during these challenging times! 👉 https://lnkd.in/eQRpHUbG 👉 https://lnkd.in/eMi7ByKj #HealthcareHeroes #CMSUpdate #MedicareSupport #PhysicianAid #CyberAttackRecovery
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Keeping the dialog open on improving/reducing denial rates--it's important to know what's wrong so we can approach solution dialogs: Fifty-four percent of denials from private payers that were initially denied were ultimately overturned and paid, "but only after multiple, costly rounds of provider appeals," according to a March 21 report from healthcare solutions company Premier. Premier conducted a survey of hospital and health system leaders representing 516 hospitals across 36 states between Oct. 10 and Dec. 31, 2023. The respondents were asked to consider all claims from Jan. 1 to Dec. 31, 2022. Here is the percentage of initial denials overturned, by payer type, according to the report: Commercial: 60.5% Medicare Advantage: 52.7% Managed Medicaid: 49.7% Medicare: 50% Medicaid: 45.8%
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CMS Says Nearly Half Of Medicare Fee-For-Service Beneficiaries Are Covered Under ACOs Modern Healthcare (1/29, Bennett, Subscription Publication) reports, “Medicare fee-for-service accountable care organizations are thriving, according to the Centers for Medicare and Medicaid Services.” Almost “half of fee-for-service Medicare beneficiaries, or 13.7 million people, are covered under ACOs this year, a 3% increase, the agency said in a news release.” According to the article, “in 2021, the innovation center declared a goal to have all fee-for-service Medicare enrollees associated with accountable care arrangements by 2030. Since then, CMS has undertaken steps to attract more providers and encourage more ACOs to form.” https://buff.ly/3HBEP2u
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Over 100 hospitals, health systems, and providers have jointly advocated for enhanced Centers for Medicare & Medicaid Services oversight regarding Medicare Advantage (MA) denials. Premier Inc., a leading healthcare services company, spearheaded the initiative, urging CMS Administrator Chiquita Brooks-LaSure to mandate thorough data collection on MA claim denials and enforce compliance with Medicare coverage guidelines. Premier's survey findings underscored the severity of the issue, revealing that while 15% of claims to private payers are denied, Medicare Advantage claims face a slightly higher denial rate of 15.7%. Moreover, hospitals incur an average administrative cost of $47.77 per appeal for denied Medicare Advantage claims. In their letter to CMS, the healthcare entities emphasized the importance of monitoring MA plans' expenditure on direct patient care to ensure alignment with beneficiaries' entitlements. Notable healthcare providers, including CommonSpirit Health, Ascension, and AdventHealth, joined the call for CMS action. Our RCM team plays a vital role in supporting hospitals by analyzing denial patterns, identifying underlying causes, and implementing effective strategies to minimize denials. Leveraging our expertise in Medicare Advantage regulations, we facilitate efficient appeals processes and advocate for fair reimbursement, ultimately striving to alleviate financial burdens on hospitals and uphold patient care standards. We are the One! #revenuecycle #revenuecyclemanagement #priorauthorization #medicalbilling #medicalcoding #healthcare #healthcaretechnology #accountsreceivables #denialmanagement #consulting #management #implementationpartner Becker's Healthcare
Dozens of health systems ask CMS to crack down on Medicare Advantage denials
beckershospitalreview.com
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On November 2nd, The Centers for Medicare & Medicaid Services (CMS) released the final 2024 Medicare Physician Fee Schedule (PFS) ruling. New on the blog, MMG's Ronnen Isakov breaks down the changes and their impact on providers: https://lnkd.in/gHb8QxHD #medicare #healthcare #healthcaremanagement #healthcarebilling
Implications of the 2024 Medicare Physician Fee Schedule Final Ruling
blog.medicmgmt.com
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Healthcare policy expert and technology leader. Healthcare and technology investor. Co-Founder/Chief Solutions Officer, Lilac Software. Healthcare blogger/podcast host. Author, The Healthcare Labyrinth. Ukraine blogger.
The 4/22 Healthcare Labyrinth Blog is live. Click below to read. After major rules on Medicare Advantage, CMS has now finalized major changes impacting Medicaid and managed care plans. #healthcare #healthcarereform #healthinsurance #healthcarelabyrinth
Major Medicaid Managed Care Changes Follow Medicare Ones - The Healthcare Labyrinth
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The 4/22 Healthcare Labyrinth Blog is live. Click below to read. After major rules on Medicare Advantage, CMS has now finalized major changes impacting Medicaid and managed care plans. #healthcare #healthcarereform #healthinsurance #healthcarelabyrinth
Major Medicaid Managed Care Changes Follow Medicare Ones - The Healthcare Labyrinth
https://www.healthcarelabyrinth.com
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CPC CPB CPMA CPCO CFPC CPC-I Coding Compliance Expert l ACDIS Leadership Council 2023-2024 l ACDIS Leadership Mentor l AAPC VILT Instructor l Published Author l SME l Educator l National Speaker
The fact that CMS is intervening as a means to sustain healthcare services lets you know the affects of this breach will leave ripples for a long time. It’s time to pull up your sleeves to do what you can to help your organizations stay above water. #medicare #medicalbilling #aapc #reimbursement #medicalbillingandcoding
Today, CMS announced a new opportunity for physicians impacted by the cyber-attack and resulting disruptions with Change Healthcare to request advance Medicare payments to help with cash flow disruptions. Details below.
CMS to advance pay to doctors affected by disruptive cyberattack
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Great reminder from CTAC on the value of Advance Care Planning to Medicare Advantage Medicare Star Ratings. And always important - how we can support the voice of individuals to be the center of all healthcare plans. https://lnkd.in/gzq9wkgC
Serious Illness and Medicare Advantage (MA) Star Ratings/HEDIS - The Coalition to Transform Advanced Care
https://thectac.org
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