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CMS Aims to Simplify with Proposed Inpatient Payment Rule

April 19, 2017

 

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 delivery of care.  The proposed rule would apply to about 3,330 acute care hospitals and 420 long-term care hospitals, and would affect discharges occurring on or after October 1, 2017.  The rule will be published in the Federal Register April 28, and comments will be accepted through June 13.

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Patient Satisfaction is The Next Competitive Battleground

April 12, 2017

 

Patient 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.

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The MACRA MIPS Composite Score: A Guide for Providers

April 5, 2017

 

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.

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CMS Delays Bundled Payment Programs

March 29, 2017

 

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 efforts to measure and provide financial incentives for quality, this system rewards volume, rather than value, for the most part, creating a system where patients and families struggle to navigate across fragmented care silos, and providers must work to maximize utilization to survive.

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An Overview of the American Health Care Act

March 22, 2017

 

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 still a high degree of uncertainty regarding what the final repeal-and-replace legislation will look like, or when it will appear, any changes to the ACA will have important implications for hospitals, health systems, healthcare professionals and patients.

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Growing Medical Debt Requires New Collection Approaches

March 15, 2017

 

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.

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11 Building Blocks of a Solid Safety Culture

March 8, 2017

 

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 antibiotic resistance to new diseases and outbreaks to sepsis prevention.

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ACOs: Who Will Lead the Way?

March 1, 2017

 

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 hospitals’ ability to maintain their dominant role in the healthcare system.

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Understanding OIG Compliance

February 22, 2017

 

On 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).

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Coalition Targets Root Causes of Health Disparities

February 15, 2017

 

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.

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National Health Expenditures and Federal Funding of Medicaid

February 8, 2017

 

In 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 percent of the Gross Domestic Product (GDP).

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Consumers, Employers and Providers Take the Hit from Rising Healthcare Spending

February 1, 2017

 

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:

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OIG Report Reveals Two-Midnight Rule Vulnerabilities

January 25, 2017

 

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 increase protections for beneficiaries.  As a result, hospitals are likely to see closer scrutiny to determine whether they are appropriately characterizing inpatient and outpatient stays.

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Healthcare Industry Strategic Trends: Takeaways from the JP Morgan Healthcare Conference

January 18, 2017

 

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 of the future in terms of strategic thinking and trends among some of the nation’s largest providers, vendors and investors.

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Healthcare’s Newest Security Threat: IoT

January 11, 2017

 

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.

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Study Shows How to Meet the Needs of Complex High-Need Patients

January 4, 2017

 

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.

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Veterans Affairs Issues Final Rule Expanding Practice Authority

December 28, 2016

 

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 professionals by increasing the number of available primary-care providers.

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2016 Healthcare Year in Review

December 14, 2016

 

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 consolidation transition is happening within a complex, highly regulated and systematized industry.  Healthcare delivery is at a crossroads with its consumers.  Patients have more control over who provides their care, how it is paid for and the way it is administered.  Consumerism is flourishing, and patients now have new tools that provide them with more transparency and control, allowing them to be better prepared to navigate the care continuum.

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Ensuring Access to Care in Urban and Rural Communities

December 7, 2016

 

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.

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Settlement Offer Announced for Appealed Medicare Claims

November 30, 2016

 

Medicare 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, and 3.7 million of those (about three percent of total claims) were appealed.

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Separating Fact from Fiction in Healthcare Medical Chart Auditing

November 23, 2016

 

Chart auditing programs have become more important in light of increased federal payer audits.  As a result, many providers want assurances that their medical chart documentation is accurate and is descriptive of the provided medical services.  Validating processes and functions in a healthcare setting follows the same principles as fact checking a news story.  Medical chart auditing is analogous to fact checking political promises or even validating a tabloid claim.

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