CMS Aims to Simplify with Proposed Inpatient Payment Rule

On April 14, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would update 2018 Medicare inpatient payment and polices. The proposed rule aims to relieve regulatory burdens for providers; supports the patient-doctor relationship in healthcare; and promotes transparency, flexibility and innovation in the deliver...
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Patient Satisfaction is The Next Competitive Battleground

IntroductionPatient satisfaction and the patient experience have always been important to providers. In today's era of value-based care reimbursement models, it has become one of the top three priorities facing healthcare executives, according to a 2013 study conducted by HealthLeaders Media.Measuring patient satisfaction has become an important dr...
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The MACRA MIPS Composite Score: A Guide for Providers

The Medicare Access & Chip Reauthorization Act of 2015 (MACRA) marked the end of Medicare payment's fee-for-service model and the beginning of a performance-based payment system, the Quality Payment Program (QPP). Understanding how participation in the QPP will impact payments begins with understanding the scoring system.Scoring in the QPP is i...
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CMS Delays Bundled Payment Programs

As noted in our eAlert issued March 16, 2016, bundled payments have long been a part of the healthcare reform debate as a strategy for reducing healthcare costs, but while there has been significant discussion and research relating to alternative payment methods, most healthcare spending is still based on a fee-for-service framework. Despite recent...
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An Overview of the American Health Care Act

The House proposal to "repeal and replace" the Affordable Care Act (ACA), the landmark and controversial legislation that is a signature of President Barack Obama's administration, indicates that the nation's healthcare system could be heading for yet another upheaval. March 21, 2017 marked the seventh anniversary of the ACA. Although there is stil...
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Growing Medical Debt Requires New Collection Approaches

The Affordable Care Act (ACA) and new payment models such as high deductible health plans are contributing to a growth in patient liability. This emerging trend has put pressure on providers to collect more from patients while better managing their financial relationship.Increases in patient liability and the responsibility of collecting it are for...
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11 Building Blocks of a Solid Safety Culture

The fact that 125,000 fewer patients died due to hospital-acquired conditions in 2010-2015, resulting in a cost savings of more than $28 billion, shows healthcare's capacity to make strides in improving safety. But despite encouraging results like these, hospitals and health systems still face a daunting array of hurdles, ranging from the growth of...
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ACOs: Who Will Lead the Way?

We are in the midst of a period that economists call "creative destruction" of our fragmented fee-for-service healthcare delivery system. The hope is that it will evolve into a higher-quality, more productive system with strong incentives for efficient, coordinated care. In any case, the transformation will have profound implications regarding hosp...
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Understanding OIG Compliance

BackgroundOn October 15, 1976, President Ford signed into law legislation creating an Office of Inspector General (OIG) at the Department of Health, Education and Welfare (HEW). HEW OIG would become HHS-OIG in 1980 when the Department was redesignated as the Department of Health and Human Services (HHS).The OIG and HHS oversee various segments of t...
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Coalition Targets Root Causes of Health Disparities

The notion that healthcare needs are human needs is gaining ground within the healthcare sector. So is the view of hospitals as important economic anchors that must address these human factors as well as the medical needs of the communities they serve, because the two sets of needs are inextricably linked.A chief catalyst for this broadened view of...
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National Health Expenditures and Federal Funding of Medicaid

2015 National Health Expenditures SummaryIn December 2016, the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS) issued a study of 2015 National Health Expenditures (NHE). According to the study, overall health spending grew by 5.8 percent in 2015 to $3.2 trillion or about $10,000 per U.S. citizen, and accounted for 17.8...
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Consumers, Employers and Providers Take the Hit from Rising Healthcare Spending

Healthcare is changing so fast it will make your head spin. Keeping up with all the changes is a huge task, even for industry insiders. Recent news reports demonstrate this: Aetna is pulling out of the various state insurance exchanges, as are United Healthcare, Humana and many of the Blue Cross/Blue Shield regional insurers. Insurance companies ar...
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OIG Report Reveals Two-Midnight Rule Vulnerabilities

A study by the Office of Inspector General (OIG) has revealed "vulnerabilities" under the Two-Midnight hospital policy that initially went into effect on October 1, 2013. In response to the findings, OIG has recommended that the Centers for Medicare and Medicaid Services (CMS) improve oversight of hospital billing under the policy and take steps to...
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Healthcare Industry Strategic Trends: Takeaways from the JP Morgan Healthcare Conference

Last week, MiraMed's senior executives attended the JP Morgan Healthcare Conference in San Francisco along with top executives from more than 450 private and public companies in biotech, pharmaceutical, medical device and technology, as well as healthcare providers, payers, private equity and venture capital firms. Presentations provided a glimpse ...
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Healthcare’s Newest Security Threat: IoT

One of the greatest technological achievements in the 21st Century was is the creation of the Internet. Its formation has effectively changed almost every aspect of business and personal communication.The newest threat to cybersecurity is the proliferation of Internet of Things (IoT)—connected physical and smart devices that have embedded technolog...
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Study Shows How to Meet the Needs of Complex High-Need Patients

Hospitals and health systems can make a more meaningful dent in the costs of care and improve the value of the care they deliver by zeroing in on the social and behavioral health needs of their most complex high-need patients, according to a new report published by The Commonwealth Fund.The problem isn't that these individuals lack access to medica...
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Veterans Affairs Issues Final Rule Expanding Practice Authority

On December 14, the Department of Veterans Affairs (VA) published a final rule amending its medical regulations to expand the scope of practice for certain Advanced-Practice Registered Nurses (APRNs) at VA facilities. The VA believes the rule, which becomes effective January 14, 2017, will make it easier for veterans to be seen by medical professio...
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2016 Healthcare Year in Review

The spotlight on the healthcare industry grows brighter every day. The industry is facing immense scrutiny on every aspect of the clinical and business drivers. Healthcare delivery is morphing from a fragmented multi-organizational industry to a more consolidated business structure where major players are merging or acquiring smaller entities. This...
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Ensuring Access to Care in Urban and Rural Communities

A report from the American Hospital Association (AHA) outlines emerging strategies to help hospitals in rural and urban communities strengthen their viability in the current environment and preserve their ability to deliver services to vulnerable populations.Developed by a 29-member task force of hospital and health system leaders and state hospita...
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Settlement Offer Announced for Appealed Medicare Claims

Review of Appeals Process and Current BacklogMedicare Administrative Contractors process an estimated 1.2 billion fee-for-service claims each year on behalf of the Centers for Medicare & Medicaid Services (CMS) for more than 33.9 million Medicare beneficiaries. Of the 1.2 billion claims filed in 2015, 123 million or about 10 percent were denied...
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