Contract Year (CY) 2020 Medicare Advantage and Part D Flexibility Proposed Rule (CMS-4185-P) On October 26, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that updates Medicare Advantage (MA or Part C) and the Medicare prescription drug benefit program (Part D) by promoting flexibility and innovation so that MA and […]
CMS Proposes to Modernize Medicare Advantage, Expand Telehealth Access for Patients Proposed rule would strengthen the popular system for private health insurance plans to provide Medicare coverage, increase plan flexibility to offer telehealth benefits, and improve coordination for dual-eligible beneficiaries In a proposed rule issued today, the Centers for Medicare & Medicaid Services (CMS) took […]
In Depth The Centers for Medicare & Medicaid Services (CMS) released a Notice of Proposed Rulemaking on Friday, October 26, 2018 (the Proposed Rule) addressing expanded telehealth coverage in Medicare Advantage (MA), extrapolation of Risk Adjustment Data Validation (RADV) audit results, and updates to the MA and Part D Quality Star Ratings program, among othertopics. […]
CMS finalizes calendar year 2019 and 2020 payment and policy changes for Home Health Agencies and Home Infusion Therapy Suppliers On October 26, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1689-F] setting out finalized Calendar Year (CY) 2019 Medicare payment updates, finalized quality reporting changes for home health agencies (HHAs), […]
The Centers for Medicare & Medicaid Services on Friday unveiled a proposal that the agency says will expand telehealth coverage to enrollees in Medicare Advantage plans. Under the proposed rule, which would take effect in calendar year 2020, Medicare Advantage plans could cover telehealth services for both rural and urban enrollees, as well as in-home […]
ACO stakeholders ask CMS to keep upside-only risk model, while 29 others from Next Gen ACO Coalition want to make risk more predictable. Susan Morse, Senior Editor Two interesting developments happened on Thursday that could impact the future of Accountable Care Organizations and the amount of risk they manage. First, 29 of the 51 Next […]
Technological advances continue to expand the healthcare delivery marketplace. Through technology, more and more providers are trying to cash in on telehealth. As with any other business, the healthcare industry is driven by profitability. In healthcare, profitability is generally driven by reimbursements from government payers such as Medicare and Medicaid, private insurers such as Blue […]
The 2019 CPT code set includes new remote patient monitoring and internet consulting codes to encourage innovative care delivery and Medicare payment for connected health. September 07, 2018 – The American Medical Association (AMA) updated the Current Procedural Terminology (CPT) code set in 2019 to include new codes for connected health services in an effort to […]
CHICAGO—The American Medical Association (AMA) today announced the release of the 2019 Current Procedural Terminology (CPT®) code set. There are 335 code changes in the new CPT edition reflecting the CPT Editorial Panel and the health care community’s combined annual effort to capture and describe the latest scientific and technological advances in medical, surgical and diagnostic services. […]
Aug 27, 2018 Today, the Centers for Medicare & Medicaid Services (CMS) released an evaluation report for the first performance year of the Innovation Center’s Next Generation Accountable Care Organization (ACO) Model showing promising early results. Results demonstrated the positive outcomes in terms of quality and costs when providers are responsible for managing to a […]
CMS has proposed three new codes for RPM services, retitled “Chronic Care Remote Physiologic Monitoring,” which do a far better job reflecting how providers can more effectively and efficiently use RPM technology to monitor and manage patient care needs, including chronic care management. If finalized, these three codes would go live January 1, 2019. CMS’ […]
August 20, 2018 As skilled nursing facilities handle more complex care, the need arises for physician input before sending patients to the hospital. Study findings reported this month in The American Journal of Managed Care® show that using telemedicine for this purpose can lead to fewer hospitalizations and savings for Medicare. CRANBURY, N.J.–August 20, 2018–When doctors could […]
The National Association of ACOs (NAACOS) argues that a rule proposed by the Centers for Medicare and Medicaid Services (CMS) to overhaul the Medicare Shared Savings Program (MSSP) begun in 2012 under the Affordable Care Act would create havoc by “introducing many untested and troubling policies.” “The administration’s proposed changes to the ACO program will […]
On August 9, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would set a new direction for the Medicare Shared Savings Program (Shared Savings Program). Referred to as “Pathways to Success,” this proposed new direction for the Shared Savings Program would redesign the participation options available under the program to […]
Today, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would overhaul the Medicare Shared Savings Program, which is the program established by the Affordable Care Act and launched in 2012 under which the vast majority of Medicare’s Accountable Care Organizations (ACOs) operate. The redesigned program is called “Pathways to Success.” […]