The Centers for Medicare & Medicaid Services, the nationís largest payer, has set a clear direction with its publication of targets: By 2018, 50% of fee-for-service payments will be through alternative payment models, such as ACOs and bundled payments, and 90% of FFS payments will be tied to quality or value. And CMS has begun to introduce mandatory bundles. This suggests that all providers will
need to develop population health competencies, including the ability to manage risk for both cost and quality.
Medicare spend per beneficiary (MSPB) information is a Centers for Medicare & Medicaid Services metric that reflects the average cost of an episode of care for Medicare patients. This measure is important to consider as part of a hospitalís national balanced scorecard, as it reflects executivesí efforts to transform the healthcare delivery system and manage the full continuum of care, including the prominent shift from inpatient to outpatient utilization.
The Truven Health Analytics 50 Top Cardiovascular Hospitals study identifies hospitals that achieve the best performance on a scorecard of performance measures. This year, based on comparisons between the winners and a peer group of similar high-volume hospitals that were not winners, the study found that if all cardiovascular providers performed at the level of this yearís winners, approximately 9,500 additional patients could survive, more than $1 billion could be saved, and almost 3,000 additional bypass and angioplasty patients could be complication-free. This is based on an analysis of Medicare patients; if the same standards were applied to all inpatients, the impact would be even greater.
In late August 2014, the Centers for Medicare and Medicaid Services (CMS) announced plans to reinstate the Recovery Audit program on a limited basis. CMS reports the delay in restarting the Recovery Audit program was to enable the various RAC regions to restructure, allowing time for the appeals to catch up. Soon, however, the hiatus will end and RACs in all regions will resume automated reviews; these will be in addition to select complex reviews based on topics chosen by CMS.
Healthcare billing and claims handling has become increasingly complex. With the transition to Version 5010 of the HIPAA electronic transaction standards, the expansion of billing codes under ICD-10, and the ever-changing requirements of insurance companies and the Centers for Medicare and Medicaid Services (CMS), it can be nearly impossible for providers to keep up.
Published By: Allscripts
Published Date: Oct 29, 2014
Download this case study to learn how SAMA HealthCare Services uses an Open platform from Allscripts to customize its healthy EHR core and focus on preventative care that is keeping patients out of the emergency room. The results? An estimated savings of $2.6 million in unnecessary ER visits and $2 million earned for Comprehensive Primary Care Initiative and Meaningful Use.
TMG Health, the largest business process outsourcing (BPO) provider in the Medicare and Medicaid market, relied on a slow, batch-oriented legacy application environment that prevented it from providing continuous data visibility and access to its clients. With help from Red Hat Consulting, TMG deployed a new application platform using Red Hat JBoss Enterprise Application Platform and other Red Hat solutions. As a result, TMG reduced development time and costs and delivered real-time data access and visibility to its clients.
Operating Rules Countdown: Enforcement Action Began April 1 - The Centers for Medicare and Medicaid Services (CMS) announced in January that enforcement action for Phase I and II Operating Rules was delayed until March 31, 2013. This phase of Operating Rules is related to enhanced delivery and content of eligibility and claim status responses.
Published By: Allscripts
Published Date: Jun 05, 2013
This paper explores the unique perspectives of both types of organizations. The participants include two of the original 32 Pioneer ACOs; the nationís largest commercial ACO; a major IDN that is pursuing its own ACO pathway; a large stand-alone hospital that has yet to take the formal step of creating an ACO but is experimenting with the model; and a large, independent, multispecialty physician group that is wary of stepping into the ACO waters.
Published By: CareCloud
Published Date: Sep 23, 2014
Gastroenterology practices today are under immense pressure from the combination of declining reimbursement and rising costs. Among other recent challenges, CMSís dramatic cuts to the 2014 Medicare reimbursement rates for upper GI endoscopy services dealt a tough blow to gastroenterologists across the country.
Published By: Comcast
Published Date: Apr 11, 2017
Like healthcare organizations elsewhere, reducing readmissions had become a top priority by 2011. Advocate, the stateís largest healthcare provider, had just signed its first shared savings agreement with Blue Cross Blue Shield of Illinois to become one of the first commercial accountable care organizations (ACOs) in the country. This event, along with others such as signing up as a Medicare Shared Savings Provider, led to re-evaluating the care continuum throughout Advocate Healthís 250 sites of care, including 13 acute-care hospitals, two childrenís hospitals and a growing home healthcare division.
Health insurance marketing is highly regulated and nuanced with complexities. Success depends upon marketers' - and their agencies' - ability to exploit knowledge of the regulatory environment as well as specialized direct/digital practices. Category expertise is critical.
MGMA Connexion™ magazine is the medical group practice professional's power resource. This popular magazine is filled with insight from peers, advice from experts and timely information on a variety of cutting-edge healthcare industry topics. MGMA Connexion™ magazine ranks as the "must-read" magazine for nearly 23,000 Medical Group Management (MGMA) members. MGMA's flagship publication is distributed ten times per year with a circulation well beyond the nearly 23,000 readers. About 50% or readers report the MGMA that they pass the issues on to other readers. This sample issue includes trend stories and member case studies, providing you a behind-the-scenes perspective on the group practice industry.
In this highly informative piece, authors Cynthia L. Dunn, RN, FACMPE and Rosemarie Nelson, MS, healthcare industry leading experts and principal consultants for the MGMA Health Care Consulting Group (www.mgma.com/consulting) have composed an in-depth look at the medical practice of the future that will allow you to learn about the following.
Are you prepared for health care reform? This 3-page checklist guides you through the general compliance requirements of the Affordable Care Act (ACA) to help you prepare now for 2014 and beyond. The checklist is broken down into five categories: 1. Health Plan Action Items; 2. Employer Tax Changes; 3. Fees and Filings; 4. Shared Responsibility Employer Preparation; and 5. ACA Provisions beyond 2014.