Allegations of fraudulent billing for catheters in 2023 will not affect calculations when Medicare analyzes financial performance of accountable care organizations (ACOs). The U.S. Centers for Medicare & Medicaid Services (CMS) has opened a 30-day public comment period on its “Proposed Rule on Mitigating the Impact of Significant, Anomalous, and Highly Suspect Billing Activity on…
Stakeholders are pleased with a Centers for Medicare & Medicaid Services (CMS) proposed rule to address the impact of widespread anomalous billing and suspected fraud involving urinary catheters that impacted Medicare accountable care organization (ACO) results. According to a Feb. 24 story in the New York Times, more than 450,000 Medicare beneficiaries accounts were billed…
Dear Healthcare Professionals, In an era where regulatory scrutiny is intensifying, the significance of governmental coding audits within the healthcare sector cannot be overstated. These audits serve as a cornerstone for maintaining compliance, ensuring the integrity of medical billing and coding practices. It is crucial to understand the complexities of these audits so you can…
This week, health data platform Arcadia made an acquisition that CEO Michael Meucci thinks will give the Boston-based company the data it needs to offer a more comprehensive suite of value-based care technology for its customers. It bought Arlington, Virginia-based CareJourney, a health analytics firm designed to facilitate participation in value-based care contracts. The acquisition…
Download Slides In this webinar, we will delve into the pivotal journey of interoperability in healthcare, exploring the significance of the Trusted Exchange Framework and Common Agreement (TEFCA), current data insights, and future directions. In this session, we will discuss: The Road That Got Us Here:– A historical overview of interoperability in healthcare.– Key…
In the dynamic landscape of healthcare, where quality care and cost-effectiveness are paramount, initiatives like the Medicare Shared Savings Program (MSSP) play a pivotal role. As healthcare providers strive to deliver better outcomes while managing costs, understanding the financial implications of MSSP Accountable Care Organization (ACO) reporting becomes essential. Understanding MSSP ACO Reporting In order…
Value-based care can make Medicare patients healthier while sustaining physicians’ practices, but it needs fine tuning within the U.S. health care system to optimize outcomes. A panel of experts shared their opinions in the “Hearing on Improving Value-Based Care for Patients and Providers,”convened June 26, 2024, by the Health Subcommittee of the House Ways &…
Value-based care — in which medical practices are paid based on the value of their care, not on volume — is a good idea but the Centers for Medicare & Medicaid Services (CMS) need to improve its implementation, doctors and a healthcare executive told members of the House Ways & Means Health Subcommittee. “I am…
Policymaker confidence in Value-Based Care and the Accountable Care Organization (ACO) model has, so far, prevailed despite only small overall savings. There is still enduring belief that ACOs can rationalize health care and produce affordability by transformative strategies. But here’s where wishes and reality conflict: ACOs have, until now, lacked the data and tools to…
In addition to generating billions of dollars in savings and improvements in quality, value-based care models have had a profound impact on the daily lives of patients and their families. Millions of patients in these models benefit from better coordinated care and services not covered by Medicare, including patient outreach and social supports like housing…