CMS Delays Release of New Hospital Compare Star Ratings

The Centers for Medicare and Medicaid Services (CMS) has postponed an update, originally slated for July, of the Overall Hospital Quality Star Ratings on its Hospital Compare website. The website is designed to serve as an information and decision-making tool for consumers, and is used as a resource by payers and providers as well.CMS said it has d...
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Integrated Services: The CHRONIC Care Act’s Potential—and Possible Pitfalls

Among other things, the CHRONIC Care Act of 2017 will allow Medicare Advantage (MA) plans to offer chronically ill beneficiaries a broader range of services and supports. One of its main purposes is to integrate medical care with non-medical long-term services and supports (LTSS), which could include everything from vision and hearing aids, transpo...
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340B Cuts Could Hurt Small, Rural and DSH Healthcare Providers

The $1.6 billion reduction in the federal 340B Drug Discount Program that went into effect in 2018 could negatively impact the operating performance of many participating non-profit hospitals, credit research firm S&P Global Ratings has reported. The Centers for Medicare & Medicaid Services (CMS) has reduced 340B payments by about 30 percen...
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CMS Explores Direct Provider Contracting, Starting With Primary Care

The Centers for Medicare and Medicaid Services (CMS) is testing the waters on a new alternative payment model (APM) through which the agency would pay participating primary care practices a monthly per-beneficiary fee for certain services, such as office visits and some office-based procedures. As with other APMs, the proposed direct provider contr...
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Studies Show Pros and Cons of Prior Authorization

A recent survey of 1,000 physicians by the American Medical Association (AMA) found that 92 percent believe prior authorizations (requirements by payers to approve a medical service, treatment plan, medication or piece of durable medical equipment [DME] before it is provided) have a negative impact on clinical outcomes. And the American Academy of ...
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HRSA Seeks Comments on Simplifying Reporting Requirements

As mandated in executive orders from the current administration, the Department of Health and Human Services (HHS) is zeroing in on ways to streamline reporting and administrative requirements for clinicians, hospitals and health systems as part of an overall effort to "reduce administrative burden" and free providers from tasks that take time away...
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HIPAA: A Gap Analysis Is Not a Risk Analysis for ePHI

When it comes to complying with the requirements of the Healthcare Information Portability and Accountability Act (HIPAA) regarding electronic protected health information (ePHI), don't confuse a gap analysis with a risk analysis, the Office of Civil Rights reminds healthcare providers in a recent bulletin.A gap analysis can help providers identify...
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CMS 2019 IPPS Proposed Rule Calls for More Transparency, Less ‘Administrative Burden’

In keeping with the current administration's emphasis on increasing price transparency in healthcare (see our March 28, 2018 eAlert), the fiscal year 2019 Inpatient Prospective Payment System (IPPS) proposed rule of the Centers for Medicare and Medicaid Services (CMS), issued on April 24, 2018, proposes that hospitals begin publishing their standar...
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Keep HIPAA Compliance on Your Radar

The secured email protocols and other measures designed to protect sensitive patient information that hospitals and billing companies have implemented during the past few years can seem like a hindrance, but they're necessary in the age of instant access to information—and cybercrime. They're also required by law. With the threat of penalties and f...
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Study Forecasts Primary and Specialty Physician Shortages

It's no secret that the United States population is aging. In just over a decade, the number of Americans in the 65-and-older age bracket will have mushroomed by 50 percent. Not as widely known is the fact that this aging population is likely to impact physician supply as well, because one-third of all currently practicing physicians will be older ...
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Will Population Value Data Destroy the Healthcare Industry

Howard A. Green, MDDermatology Associates, PA, Palm Beach, FLThere's nothing new about 'population health.' Physicians practicing medicine (notice I didn't say practitioners practicing healthcare) have utilized population health studies or 'clinical studies' for the better part of two centuries. Physicians practicing medicine with patients observed...
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Senate and House to Review Opioid Bills

Committees of the House and Senate have introduced a wave of legislation to address the opioid crisis, including more than 30 bills related to Medicare and Medicaid coverage and payment. Highlights of the Opioid Crisis Response Act of 2018, introduced by the Senate Health, Education, Labor and Pensions Committee, include enhancing state prescriptio...
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RAC Changes on the Horizon

The controversial Recovery Audit Program of the Centers for Medicare and Medicaid Services had garnered criticism from the American Hospital Association and other groups for its role in generating a huge backlog of appeals that can take months, if not years, to resolve, straining hospitals' financial resources in the process. A 2017 study published...
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Lawmakers Renew Call for Healthcare Price Transparency; Stakeholders Comment

The federal government has turned the spotlight once again on the issue of price transparency in healthcare, with a bipartisan group of senators reaching out to a large swath of stakeholders for input and Secretary of Health and Human Services Alex M. Azar II naming it as a pillar of an agenda to increase value and lower costs for consumers. The ke...
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CMS Official Outlines Plans to Simplify MACRA

Some significant regulatory changes could be coming this year to the Quality Payment Program (QPP) of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) as part of an effort to lighten clinicians' administrative and quality reporting workloads. The update comes from Kate Goodrich, MD, chief medical officer of the Centers for Medicare ...
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HIMSS 2018: News and Trends from HIT’s Big Meeting

Developments in artificial intelligence (AI), precision medicine, cybersecurity and patient engagement were among the highlights of this year's conference of the Chicago-based nonprofit Health Information Management Systems Society (HIMSS). The meeting brought together more than 40,000 health information technology professionals from 50 countries t...
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Will Net Neutrality Repeal Help or Hurt Healthcare Providers?

The Federal Communications Commission (FCC) published its order on February 22, 2018 to repeal net neutrality, a set of regulations grounded in the premise that internet service providers should treat all web traffic equally as it passes through their networks. The order's publication follows a vote by the FCC in December to rescind the net neutral...
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A Refresher: The Quality Payment Program Revisited

The Quality Payment Program (QPP) is designed to improve Medicare outcomes by helping focus on care quality and making patients healthier. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate formula, which has created a rift between physicians and the government. This payment model had severe financial...
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Drug Shortages Persist: An Update for Hospitals and Health Systems

Drug shortages can lead to a variety of complex adjustments in medical treatment that have the potential to jeopardize patient safety and interfere with the quality of care. And they remain a serious public health problem. A 2016 study by the Government Accountability Office (GAO) showed that, while the number of new drug shortages has trended down...
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What are Comparative Billing Reports and Why Should Medical Groups Care?

They might seem innocuous and inconsequential in a medical group's vast sea of paperwork and electronic data, but comparative billing reports (CBRs), administered by the Centers for Medicare and Medicaid Services (CMS) and prepared by a data mining company called eGlobalTech (eGT), are not something to ignore. Medical practices need to know what CB...
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