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CMS Announces New TPE Audit Program Print E-mail
Written by Sharon Parsley | Florida Healthcare Law Firm   
Tuesday, 26 September 2017 19:05

The Centers for Medicare & Medicaid Services (CMS) relies on its Medicare Administrative Contractors (MACs) to serve as guardians of the Medicare trust fund through the MACs taking steps to prevent improper payments.  Despite that reliance, in its most recent report to the U.S. Senate Finance Committee, the Government Accountability Organization(GAO) reports that improper payments totaling $41.1 billion (no, that is NOT a typo, that is a "b") occurred during 2016 in the Medicare fee-for-service program. That figure represents an overall 11% percent improper payment rate.
How many of us would feel good about being "wrong" in our core job function 11% of the time? Not very many of us, I suspect.
The GAO report goes on to quote the MACs as generally having ongoing concerns about the following types of claims as those which pose the greatest financial risk to the Medicare trust fund.
Last Updated on Tuesday, 26 September 2017 19:07
CMS cancels cardiac bundles, scales back CJR model: 8 things to know Print E-mail
Written by Ayla Ellison | Becker's Hospital Review   
Wednesday, 16 August 2017 00:00

CMS issued a proposed rule Tuesday <8/15/17> that would cancel or scale back major bundled payment initiatives.

Here are eight things to know about the proposed rule...

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What is care coordination and why does it matter? Print E-mail
Written by Accountable Care Options   
Wednesday, 05 July 2017 16:54

Care coordination has taken primacy in patient care, but not everyone understands what that means. Some physicians will hear the term and say, “I've always coordinated the care of my patients."

On a granular level, that’s true. Doctors have traditionally written orders, obtained offers and referrals from insurers, and sent patients to specialists for further evaluation and treatment.
In the context of healthcare reform, care coordination has a different meaning. It has expanded to all stakeholders in a patient’s health. Primary care physicians must open and maintain lines of communication with everybody involved in a patient’s care, including the individual’s family and social circle.
Why look beyond professionals? The first reason is to obtain and share health information such as surgical history, medication, most recent lab results, family and cultural traditions, and beneficiary preferences for care.

The goals are to reduce duplications of services and decrease the growth in health care expenditures for low-value services. Studies show that while some treatments do little to improve beneficiary health, they continue to be prescribed. When everyone talks about how to better patient care, more time and money is spent on treatments and lifestyle changes that have an impact.
The burden for coordinating care falls largely on primary care physicians. They ask each patient for a list of everyone involved with contact information. With patient consent, primary care physician can send data to other care providers and ask, “The next time you see the patient, would you be so kind as to give me feedback?" Once everyone is on board, collecting and sharing information becomes faster and easier.

The benefit goes beyond better care. CMS publishes practitioner data, and every physician has a financial incentive to achieve superior rankings for outcomes and efficiency. Top scores make the practice more attractive to patients and insurers seeking the highest quality at the lowest cost.

The tools to determine who’s best – and worst – are available to anyone, and payors have sophisticated means to evaluate practices. The simplest measure is the Consumer Assessment of Healthcare Providers and Systems, or CAHPS, survey. Among the questions, patients are asked, "Does your doctor seem informed about what other doctors are doing? Yes or no." The answer impacts beneficiary satisfaction scores and ultimately a practice’s bottom line.

Last Updated on Wednesday, 05 July 2017 17:00
10 Takeaways from the 2018 MACRA Proposed Rule Print E-mail
Written by Gabriel Perna | Physicians Practice   
Thursday, 22 June 2017 00:00

This week, CMS released the proposed rule which outlines the 2018 performance year requirements of its Quality Payment Program (QPP), under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

For small practices, it should be seen as a major win, early observers of the rule say. CMS created a number of flexibilities in the QPP that will allow practices with 1 to 15 physicians (its definition of small) to either skip participation altogether or have an easier time adhering to the guidelines.

The American Medical Association (AMA) praised the rule shortly after it was released.

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Post-acute care: Medicare Advantage vs. traditional Medicare Print E-mail
Written by Austin Frakt | The Incidental Economist   
Saturday, 20 May 2017 10:46

From a public spending point of view, post-acute care is particularly problematic. Most of Medicare's geographic spending variation is due to this type of care. Part of the story is that Medicare pays for post-acute care in several different ways, with different implications for efficiency.

 For example, traditional Medicare (TM) - which spends ten percent of its total on post-acute care - pays skilled nursing facilities per diem rates but inpatient rehabilitation facilities a single payment per discharge. Post-acute care is also available through Medicare Advantage (MA), which operates under a global, per-enrollee, payment. Unlike TM, MA plans establish networks, may require prior authorization for post-acute care, and can charge more in cost-sharing for post-acute care than TM does.

These different payment models offer different incentives that may affect who receives care, in what setting, and for how long. In Health Affairs, Peter Huckfeldt, José Escarce, Brendan Rabideau, Pinar Karaca-Mandic, and Neeraj Sood assessed some of the consequences of those incentives.

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Last Updated on Friday, 16 June 2017 17:41
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