topic: Medicare
Get Ready for a Successful Health Plan Audit By Shanti Wilson
Depending on which types of patients you serve, your health plan audit may be made by many regulatory entities. Your compliance department should be notified when an audit will be conducted. If you do not have a compliance department, your point of contact will typically be in your C-Suite, such as your CEO or CFO.
Determining PAC Networks with Medicare's New CJR Program By Debra Mathias
As seen in Healthcare Informatics. Hospitals participating in Medicare’s mandatory new Comprehensive Care for Joint Replacement (CJR) reimbursement model need to develop a high-quality preferred post-acute care (PAC) network to which they can discharge high-risk CJR patients. Hospitals can do so either independently or by using an external consultant. The PAC must, per CMS, have a minimum 3-star rating or reimbursement will be negatively impacted. By developing a PAC preferred provider network based on objective criteria and supported...
Navigate Effectively through Medicare’s CJR Program – An Overview By Debra Mathias
As seen in Healthcare Informatics. Experience is no substitute for expediency. Consider the example of Edward John Smith, Captain of the maiden (and final) voyage of the RMS Titanic in 1912. Despite being one of the world’s most experienced sea captains, Smith failed to change the Titanic’s course or reduce speed, even though he knew his ship was headed straight into a massive iceberg zone. We all know how that story ends. Similarly, despite a massive sea change in health...
ACOs: Implementing and Sustaining Value-Based Change By Bob Wadsworth
As seen in Health Intelligence Network. Just as “Rome wasn’t built in a day,” neither is an efficient, sustainable, and physician-focused accountable care organization (ACO). Instead, expect to embrace a stair-step approach to making the necessary changes in your care delivery and administrative practices. Competency and capability development is always multi-dimensional, so consider these five steps as a benchmark for your organization’s critical thinking on ACO development. Introduction In California, we’re now in what could be termed the “second generation”...
Need to Know: Key Provisions in the 2016 Medicare Physician Fee Schedule Proposed Rule By Emily Richmond
The Centers for Medicare and Medicaid Services (CMS) has released the 2016 Medicare Physician Fee Schedule proposed rule, the first proposed fee schedule updates since the repeal of the Sustainable Growth Rate (SGR) formula by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The 2016 Medicare Physician Fee Schedule proposals reflect a focus on quality program-specific provisions, and align with CMS and Congress’ stated intent to continue shifting the Medicare program towards a system that rewards high-quality care...