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Resources to Drive Performance and Profitability:

Telehealth: Five Things to Know About Payor Reimbursement

Telehealth, policy develops much more slowly than the rapidly advancing technology. Incremental changes are taking place to further develop telehealth legislation. In 2017, 210 telehealth related bills were active across thirty states. One of the most common pieces of legislation relate to...

The Paradigm Shift for Hospice Providers Begins

A number of key trends are impacting the future of hospice providers. Four key trends contribute to the paradigm shift: Principal diagnoses are changing. Expenditures are expected to increase by 8% annually. Expanded role of physician assistants …. now has a “twist.” A Meaningful...

MarketScan: Payors Expanding Into Palliative Care

Payors and Alternative Payment Models (APMs) are turning to palliative care programs as a way to offer value-based end-of-life care. Learn how changes affect the future.  By: Lisa Remington, President Remington Health Strategy Group, Publisher, The Remington Report The palliative...

How is the Industry Finding Solutions To Social Determinants?

Transportation barriers to healthcare, affect approximately 3.6 million Americans today. Missed appointments are a costly problem for providers and insurers, with estimates running upwards of $150 billion a year  in the U.S., according to the Washington Business Journal. The Transit...

Readmission Analysis By Payor: Seven and Thirty Day By Diagnosis

In 2014, 14 percent of inpatient stays were readmitted within 30-days. More than one-third of these readmissions occurred within 7-days, reflecting a 7-day readmission rate of 5 percent.  By: Lisa Remington, President Remington Health Strategy Group, Publisher, The Remington...

What Does A Unified PAC Payment System Look Like?

Some operational and administrative requirements are relatively similar across PAC settings. Exploring similarities flushes out what is presently aligned for the model to work, and identifies where there are gaps that need more oversight or policy changes. By: Lisa Remington, President...

Medicare Advantage Plans: Functional Status Not Accounted

The 21st Century Cures Act contains a provision for the General Accounting Office (GAO) to report on issues related to incorporating functional status into MA risk adjustment. The Centers for Medicare & Medicaid Services (CMS) pays Medicare Advantage (MA) plans a monthly capitated amount to...

Four Ways Medicare Advantage Plans Manage Post-Acute Providers

MA plans contract with only a select number of post-acute care providers. In order to win these MA contracts, post-acute care providers need to prove their value. They need to convince MA plans that they have lower costs and good patient outcomes. MA plans contract with only a select number of...

What Providers Can Do About Denials From Medicare Advantage Plans

According to a Report from the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) entitled, "Medicare Advantage Appeal Outcomes and Audit Findings Raise Concerns About Service and Payment Denials," published on September 27, 2018, Medicare Advantage Plans...

Hospitals Can Provide Free In-Home Services to Discharged Patients

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) posted Advisory Opinion No. 10-03 on March 6, 2019, which permits hospitals to provide free, in-home follow up care to discharged patients. By: Elizabeth Hogue, Attorney The hospital that requested...

2019 Quality Measures Under Consideration

HHS is statutorily-required to establish a federal pre-rulemaking process for the selection of certain quality and efficiency measures  for use by HHS. By: Lisa Remington, President Remington Health Strategy Group and Publisher, The Remington Report  One of the steps in the...

Emergency Triage Model To Improve Chronic Care

Six common chronic conditions accounted for 60% of the 24 million visits in 2017. A study by Premier of nearly 24 mission ED visits across 750 hospitals found that approximately 4.3 million visits associated with patients who have at least one of the six chronic conditions were potentially...

Episode-Based Vs. Stay Based Payments: Discussions for Future Payments

The Medicare Payment Advisory Commission (MedPAC) is discussing how to proceed on creating a unified prospective payment system to improve the accuracy of Medicare fee-for-service payments for post-acute care settings (HHA, SNF, IRF, and LTCH). By: Lisa Remington, President, Remington Health...

2019 Guidelines for Home and Community-Based Services

CMS issued new guidance to clarify where Medicaid beneficiaries can receive home- and community-based services as defined in a 2014 regulation.  The guidelines in the HCBS final rule establishes new reimbursement criteria. By: Lisa Remington, President Remington Health Strategy Group...

PDGM Model: Analysis By Type of Agency

In 2017, about 3.4 million Medicare beneficiaries received home care, and the program spent $17.7 billion on home health services. Medicare spending for home health care more than doubled between 2001 and 2017, and this care accounted for about 3 percent of Medicare fee-for-service (FFS) spending...

Home Care For Hip And Knee Patients Have Lower Costs

Large studies support that patients sent home after knee and hip replacements do not have higher rates of medical complications, returns to the hospital or emergency room visits than those who went to rehabilitation facilities. By: Lisa Remington, President, Remington Health...

How ACOs Manage High-Risk, High-Need Patients

A study in The American Journal of Accountable Care analyzed the clinical and administrative workforces of 17 ACOs. An aspect of the analysis looked at the resources needed to reduce the overall cost of care by improving care for high-risk patients. The study provides a window into how ACOs...

Physician Self-Referral Laws: Is Reform On Its Way?

Enacted in 1989, the Stark Law has turned into an outdated set of legal requirements inhibiting and blocking the ability to move into value-based care. This is important to learn about as it will change our future healthcare delivery system. In February 2018, Congress passed and President Trump...

16 Things To Know About Stark Laws

The Stark Law is a set of United States federal laws that prohibit physician self-referral, specifically a referral by a physician of a Medicare or Medicaid patient to an entity providing designated health services ("DHS") if the physician (or an immediate family member) has a...

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