Category: Revenue Cycle Management

three-key-targets-for-payers-during-medicare-open-enrollment

Three Key Targets for Payers During Medicare Open Enrollment

Affordability, simplicity, and accessibility remain the three targets that payers aim to hit during Medicare open enrollment season, according to Christopher Ciano, president of Aetna Medicare. Listen to the full podcast to hear more details. And don’t forget to subscribe on iTunes, Spotify, or Google Podcasts. The push for greater affordability is perhaps most evident […]
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CMS Releases Physician Fee Schedule Final Rule

  CMS says it the goal is to support health equity while focusing on high-quality person-centered care. Increased leverage of telehealth for behavioral care, diabetes prevention and mitigation, and enhanced payment for vaccine administration were three out of many priorities cited by federal officials who announced the release of the Centers for Medicare & Medicaid […]
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CMS Releases Final Rule for CY 2022 Medicare Physician Fee Schedule

CMS has finalized the calendar year (CY) 2022 Medicare Physician Fee Schedule to promote greater telehealth utilization, boost reimbursement rates for vaccine administration, and improve health equity, among other initiatives, the federal agency said. The final rule will implement “a series of standard technical proposals” as part of CY 2022 rate-setting, CMS said. The conversion […]
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The Role of Provider-Sponsored Health Plans in Value-Based Care

Provider-sponsored health plans can be naturally aligned with value-based care goals while also being attuned to providers’ needs. Providence Health Assurance’s Medicare Advantage provider-sponsored health plan received a five-star rating through the CMS Medicare Advantage Star Ratings system for the 2022 Medicare open enrollment season. The health plan, which serves Oregon and Washington State, is […]
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CMS Updates End-Stage Renal Disease APM, PPS to Address Health Equity

The End-Stage Renal Disease (ESRD) Treatment Choices Model is the first to undergo changes to directly address health equity—a new goal for CMS-run alternative payment models. The ESRD Treatment Choices (ETC) Model is a mandatory alternative payment model (APM) that encourages greater utilization of home dialysis and kidney transplants for Medicare beneficiaries with the chronic […]
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Medicare drops end-stage renal disease payment rule that aims to close health equity gaps

The Biden administration dropped a final rule Friday that will reward providers that improve rates of home dialysis and kidney transplants among low-income Medicare and dual-eligible beneficiaries. The goal of the changes is to encourage dialysis providers to decrease disparities in home dialysis and transplant rates, part of a larger effort by the Biden administration. […]
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AHA Calls for Medicare Advantage Inclusion in Prior Authorization Rule

The American Hospital Association (AHA) has asked CMS to include Medicare Advantage organizations in its proposed rule that would streamline the prior authorization process and reduce patient care delays. In December 2020, CMS released a notice of proposed rulemaking about improving prior authorization, following past administrative and clinician struggles. If the rule is finalized, there […]
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2022 Medicare Advantage Plan Overview, Part Three: Social Determinants

  “Medicare Advantage plans have a unique and growing opportunity to address the needs of socioeconomically vulnerable populations and improve their health,” reports America’s Health Insurance Plans. More plans for individuals with low incomes, as well as targeted SDOH investments and initiatives, round out carrier approaches. On the benefits side, offerings such as meals, transportation, […]
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