The U.S. healthcare industry is moving toward value-based care, encouraged by reimbursement initiatives from the Centers for Medicare and Medicaid Services (CMS). In a value-based model, providers are paid depending on patient outcome rather than on volume of procedures performed. Theoretically, this would promote a focus on patient wellness and preventative medicine, which would improve […]
Implementation of a single E/M payment rate for office visit Levels 2 through 4 won’t go into effect until 2021, CMS stated in the new Physician Fee Schedule rule. November 01, 2018 – CMS will collapse evaluation and management (E/M) payment rates, but not until the 2021 calendar year, according to the recently released final 2019 […]
With the recent rise in medical services provided outside of a doctor’s office, there has been a surge of FCA enforcement actions against home health agencies (HHAs). HHAs are public or private agencies or organizations that are primarily engaged in providing skilled nursing services and other therapeutic services to patients in their residence.[1] The last […]
Despite hospital systems and health officials calling out the need for more primary care doctors, graduates of U.S. medical schools are becoming less likely to choose to specialize in one of those fields. A record-high number of primary care positions was offered in the 2019 National Resident Matching Program—known to doctors as “the Match.” It […]
After pushing more medical care out of hospitals and into patients’ homes, the federal government wants to pay less for home health care. Impending changes in Medicare’s home health payment system would dramatically alter how agencies are reimbursed for services, cutting payments by 8 percent. Lower rates would squeeze profit margins in what has been […]
The Bipartisan Budget Act of 2019, signed into law last week by President Donald J. Trump, includes an extension of the Medicare sequestration cuts for an additional two years. This across the board cut of two percent applies to all Medicare provider payments. The Bipartisan Budget Act of 2019 will increase federal spending by $320 […]
Beginning January 2020, primary care practitioners may qualify to participate in one of five new payment model options that focus on supporting care for patients who have chronic conditions and serious illnesses. The Centers for Medicare & Medicaid Services’ (CMS) Primary Care Initiative is a new set of payment models that will provide primary care […]
As Wei Wei Lee sat with her doctor to discuss starting a family, she felt a “distance” between them. The physician was busy on the computer and focused on the screen. Health care — and how much it costs — is scary. But you’re not alone with this stuff, and knowledge is power. “An Arm […]
One piece of information you may find surprising from an Aug. 21 Centers for Medicare & Medicaid Services education call, “Home Health Patient-Driven Groupings Model: Operational Issues,” regards payment hold time. As always, Medicare contractors will hold home health agency claims between Jan. 1 and when system changes get installed — this year, Jan. 6. The period of time is usually […]
Members, please pay close attention if you are a Medicare provider. All new Medicare cards have been mailed. The Centers for Medicare and Medicaid Services (CMS) is encouraging providers to use Medicare Beneficiary Identifiers (MBIs) NOW to protect patients’ identities as providers must use MBIs beginning January 1, 2020. Providers claims will get rejected if they submit with Health […]