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Action needed: Register for an iQIES Account

The Quality Improvement and Evaluation System (QIES), which providers and vendors use to submit assessment data, is being upgraded to make the system more reliable, scalable, secure, and accessible.  The enhancements will occur in phases (by provider type) and began with Long- Term Care Hospitals (LTCHs) in March 2019, followed by Inpatient Rehabilitation Facilities (IRFs)

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Congress Debates Bill to Automate Prior Authorization in Medicare Advantage Plans

Recently the House of Representatives’ Small Business Committee convened for a hearing on utilization management and barriers to care in small medical practices. In particular this hearing focused on the application of prior authorization within Medicare Advantage (MA) plans and the associated challenges faced by patients and providers of services due to prior authorization requirements.

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Physician Stark Law Rules Revamped: New Rules Address Care Coordination

This is the first major update to rules for the Stark law since 1989, according to HHS. An HHS press statement explained that the new rules would give providers in value-based arrangements “greater certainty” and “ease the compliance burden for healthcare providers across the industry,” while maintaining protections against fraud and abuse. Clinicians and hospital

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Home Care Agencies Often Wrongly Deny Medicare Help To The Chronically Ill

Colin Campbell needs help dressing, bathing and moving between his bed and his wheelchair. He has a feeding tube because his partially paralyzed tongue makes swallowing “almost impossible,” he said. Campbell, 58, spends $4,000 a month on home health care services so he can continue to live in his home just outside Los Angeles. Eight

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3 Benefits of Value-Based Care

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

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CMS Delays Collapsing of E/M Payment Rates Until 2021

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

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Increased Enforcement Against Home Health Agencies

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

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American medical students less likely to choose to become primary care doctors

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

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Medicare decides a cost-saving strategy costs too much

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

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Medicare Sequester Extended Two Years

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

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CMS Is Putting Primary Care First

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

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When A Doctor’s Screen Time Detracts From Face Time With Patients

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

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Take A Look At Latest PDGM Clarifications from CMS

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

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New Medicare Card: Transition Period Ends in Less Than 5 Months

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

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Can an ACO Benefit Independent Physicians?

An Accountable Care Organization (ACO) is a voluntary association of healthcare providers that bases physician reimbursement on performance quality and outcomes in order to lower overall costs. This method incentivizes physicians to deliver higher-quality care at an affordable cost, and is replacing the traditional fee-for-service model that has dominated healthcare in the past. The Medicare

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Bankruptcy Court Stops Medicare from Recouping Monies Owed by Provider

A Delaware Bankruptcy Court Judge has entered an order prohibiting Medicare from withholding payments to a diagnostic testing provider, True Health Diagnostics, LLC, while the bankruptcy case is pending. Prior to filing the bankruptcy case, Medicare identified two large overpayments owed by True Health and also suspended its future payments. The Judge determined that it

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Medicare’s New 'Preclusion List'

By way of background, let’s start with a short Medicare primer. The federal Medicare program is a government health insurance program that pays for certain health care services for individuals who are 65 or over and have paid into Social Security and Medicare through payroll taxes for the required periods; certain younger people with disabilities;

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NAHC Submits Comments to CMS on Proposed Home Health Cost Report Changes

The National Association for Home Care & Hospice (NAHC) and the Home Health Financial Managers Association (HHFMA) submitted comments on the Centers for Medicare & Medicaid Services (CMS) proposed changes to the home health cost report (Form CMS-1728-19) and cost reporting instructions. On April 16, 2019, the CMS published notice in the Federal Register of plans to revise the

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How will the EMPOWER Care Act affect HHAs?

The Empower Care Act (Ensuring Medicaid Provides Opportunities for Widespread Equity, Resources, and Care) was re-introduced to the senate early in 2019. This bill is intended to expand as well as renew/reauthorize funding and participation in the transitioning of Medicaid beneficiaries from hospital or institutional settings to home and community-based services under the Money Follows

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Program for Evaluating Payment Patterns Electronic Report

New Home Health Agency PEPPER Available The Q4CY18 release of the Home Health Agency (HHA) Program for Evaluating Payment Patterns Electronic Report (PEPPER) with statistics through December 2018 is now available for download through the PEPPER Resources Portal. To obtain your agency’s PEPPER, the Chief Executive Officer, President, Administrator or Compliance Officer should: Review the