The Healthcare industry is facing implications from the pandemic situations that can impact their ability to improve contract performance and potentially expose them to new risks. Value-based contracts are usually relying on historical data for starting claim targets, trend rates, and/or quality measures. Impact on claims The timing and severity of this pandemic situation is […]
The American Hospital Association (AHA) is calling on CMS to re-evaluate payment options for hospitals that accepted accelerated Medicare payments at the early stage of the COVID-19 pandemic. The hospital group requested CMS Administrator Seema Verma to allow all hospitals to elect to receive periodic interim payments (PIP) or accelerated payments, per initial CMS communications […]
The CMS (Centers for Medicare and Medicaid Services) and CDC (Centers for Disease Control and Prevention) recently announced provider reimbursement update available to physicians and health care providers to counsel patients, at the time of coronavirus disease 2019 (COVID-19) testing. Providers educate patients about the importance of self-isolation once they are tested and prior to […]
Early in August 2020, the Medicare Accelerated & Advance Payment Programs will start to recover the $100 billion in Medicare reimbursements advanced to hospitals and physicians to ease cash flow issues they experienced in March when a handful of COVID-19 cases turned into a national public health emergency. Major hospital groups are asking Congress to […]
The paycheck protection program is a key resource for small healthcare organizations and the program is established by the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This act provides loans up to USD 10 million for businesses with fewer than 500 total employees. The loans can be fully forgiven if at least 60 percent […]
Oncology practitioners in CMS’s Oncology care model (OCM) are willing to take on two-sided risk, according to the Community Oncology Alliance (COA) survey. The oncology practitioners are confident they can get success in providing quality and cost-effective cancer care as the healthcare system undergoes the shift from fee-for-service to value-based care. Community Oncology Alliance surveyed […]
Value-based reimbursement inspires clinicians to care for the whole person, who is essential to addressing health disparities confirmed by claims data from the COVID-19 crisis, CMS says. Health disparities confirmed by Medicare claims data for the period of the COVID-19 crisis underscore the need to transition to value-based reimbursement, according to CMS. Health disparities evident in the […]
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) enforced CMS to implement an incentive program called the Quality Payment Program as MACRA ended the Sustainable Growth Rate (SGR) formula, which significantly cut payment rates for participating Medicare clinicians. Now, clinicians can choose the following ways to participate in the Quality Payment Program: Merit-based […]
Recently, the president signed the Paycheck Protection Program Flexibility Act of 2020 (HR 7010), since this law does not integrate any kind of additional funding to the Small Business Administration (SBA) Paycheck Protection Program (PPP) loan program. The payment protection program offers small businesses with funds in order to pay up to eight weeks of […]
As per the Medical Group Management Association (MGMA) increasing the revenue of the practice rely largely upon filing correct claims which satisfy all reporting guidelines, filing appeals, and tracking denials within the timeline. Apart from this, keeping your business financially healthy is not a simple practice as practices changing from the fee-for-service model to value-based care. […]
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