Author: The PMB Pulse

Healthcare EHRs at a Crossroads: Innovate or risk being left behind?

The healthcare technology landscape is constantly evolving, and a crucial question emerges: are established EHR systems, like EPIC, at risk of becoming outdated if they don’t adapt to changing needs and technological advancements? Disruptions have occurred in the past. Blockbuster, once a leader, didn’t adapt to streaming and declined. Netflix embraced innovation and succeeded. This […]

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Q4 2024 Medical Review Denial Trends in Home Health

Palmetto GBA has published its quarterly summary of the top denial reason codes for home health agencies (HHAs) for Q4 2024. These denial reasons offer insight into common compliance pitfalls and documentation errors that directly affect claim approvals and agency cash flow. Top Reasons for Denials in Home Health Include: Each of these denial codes […]

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HIPAA Rule Changes Set to Reshape Compliance Landscape in 2025

As 2025 unfolds, significant updates to HIPAA regulations are on the horizon, with sweeping changes aimed at increasing patient access to health data while tightening data privacy and security protocols. Healthcare providers should prepare for these changes now to avoid compliance pitfalls and potential financial penalties. The U.S. Department of Health and Human Services (HHS) […]

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CMS Pauses Hospice Special Focus Program for Further Evaluation

On February 14, 2025, the Centers for Medicare and Medicaid Services (CMS) stopped introducing the Hospice Special Focus Program (SFP) to conduct a more thorough assessment. This break is a necessary step to recognize that the program is not achieving its intended goals in its current format. The hospice community has long supported strong patient […]

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URGENT: New Regulation Requiring Notice of Medicare Non-Coverage to Include BFCC-QIO Information

A new regulation has been released regarding Medicare Advantage plans. If you are providing home health services to a patient enrolled in a Medicare Advantage plan, you are now required to issue the Notice of Medicare Non-Coverage. This notice must include information about the BFCC-QIO, allowing patients the opportunity to appeal decisions related to their discharge. […]

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New CMS Interpretation on Face-to-Face Encounters Creates Challenges for Providers

Healthcare providers have been facing significant challenges with PCR (Pre-Claim Review) requests in recent months, following a new directive from CMS (Centers for Medicare & Medicaid Services) to Palmetto GBA. The change in interpretation, which began impacting providers in late November, requires a face-to-face encounter performed by the certifying physician or nurse practitioner (NP) for […]

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Termination of the Hospice Benefit Component of the VBID Model

The Centers for Medicare & Medicaid Services (CMS) has announced that the Hospice Benefit Component of the Value-Based Insurance Design (VBID) Model will officially end on December 31, 2024, at 11:59 PM. This decision impacts Medicare Advantage Organizations (MAOs) participating in the Hospice Benefit Component and requires them to make adjustments to ensure continued compliance […]

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2025 Medicare Part B Premiums and Deductibles: Key Updates for Providers

CMS has announced the updated Medicare Part B premiums and deductibles for 2025. These changes, which reflect adjustments for rising healthcare costs and program expenses, are critical for providers to understand as they plan their billing and patient communications for the year ahead. 2025 Updates to Part B Premiums and Deductibles Premium Increases Deductible Changes […]

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Die symbolische Bedeutung in der Geschichte: Von alten Kulturen bis zur modernen Welt

1. Einführung in die symbolische Bedeutung in verschiedenen Kulturen Symbole sind fundamentale Bestandteile menschlicher Kulturen und spiegeln tief verwurzelte Werte, Überzeugungen und Weltanschauungen wider. Sie dienen seit Jahrtausenden als universelle Sprache, die über geografische und sprachliche Grenzen hinweg kommuniziert. In verschiedenen Gesellschaften wurden Symbole genutzt, um religiöse Überzeugungen zu vermitteln, soziale Hierarchien zu markieren oder […]

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CMS Finalizes the 2025 Medicare Physician Fee Schedule

CMS has released the Calendar Year (CY) 2025 Medicare Physician Fee Schedule (PFS) Final Rule, outlining key updates to payment policies, payment rates, and other provisions under Medicare Part B. These changes directly affect physicians and healthcare providers across the country, influencing reimbursement rates and practice operations. Key Updates in the 2025 Fee Schedule 1. […]

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