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MiraMed’s eAlerts are distributed via email every Wednesday, and contains the latest industry information regarding business process outsourcing solutions, helpful coding news, or any number of relevant topics in the fast-paced, ever-evolving world of healthcare. To subscribe, simply complete the form below. Below the subscription form, you will find the archived eAlerts available.

Integrated Services: The CHRONIC Care Act’s Potential—and Possible Pitfalls

June 13, 2018

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, transportation services and scooters to environmental modifications such as grab bars and raised toilet seats to better meet the health and well-being needs of chronically ill patients.

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340B Cuts Could Hurt Small, Rural and DSH Healthcare Providers

June 6, 2018

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 percent for most medication for 2018.  According to a 2015 report by the Medicare Payment Advisory Commission, about half of United States hospitals are now 340B participants.

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CMS Explores Direct Provider Contracting, Starting With Primary Care

May 30, 2018

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 contracting (DPC) model would offer participating clinicians performance-based incentives related to quality and cost. Features of the model would include the ability for participants to take on two-sided financial risk, as well as voluntary enrollment by beneficiaries and development of new ways to streamline claims submission and lighten physicians’ administrative burden.

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Studies Show Pros and Cons of Prior Authorization

May 23, 2018

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 Family Physicians calls prior authorizations “the number-one administrative burden” for family physicians.

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HRSA Seeks Comments on Simplifying Reporting Requirements

May 16, 2018

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 from care delivery and quality improvement.  Toward that end, a Regulatory Reform Task Force of representatives from each of the HHS agencies has begun identifying potential “deregulatory” actions with input from stakeholders.  In a recent request for information (RFI), HHS’s Health Resources and Services Administration (HRSA) solicited comments and input on proposed changes to several of its programs.

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