Category: Revenue Cycle Management

cms-to-tie-vaccine-mandate-to-medicaid-medicare-participation

CMS to Tie Vaccine Mandate to Medicaid, Medicare Participation

  A COVID-19 vaccine mandate for healthcare workers will be tied to Medicaid and Medicare Conditions of Participation (CoP), the Biden-Harris Administration recently announced. The announcement made via CMS yesterday said the Administration will require COVID-19 vaccination of staff in all Medicaid and Medicare-certified facilities by October. The emergency regulation, when it is released, will […]
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Top 3 Member Engagement Benefits of Using Omnichannel Tools

Omnichannel strategies are becoming increasingly significant to successful member engagement. What is omnichannel engagement? Omnichannel engagement is a strategy that originated as a sales and marketing term but has infiltrated various sectors of the healthcare industry with the rise of healthcare consumerism. This strategy involves using various consumer touchpoints to push a product in a […]
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biden-administration-drug-plan-includes-value-based-payment-ideas-for-medicare

The Biden Administration Drug Plan Includes Value-Based Payment Ideas for Medicare

The administration said it would make the results of its drug price negotiations with manufacturers, as well as its approach to value-based care models, open to a variety of payers. The Biden administration Thursday released its plan to reduce prescription drug prices, which would include the use of models to test value-based payments in Medicare […]
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The CMS provides additional ARP funding to states to promote insurance affordability

The Centers for Medicare and Medicaid Services and the Biden Administration have earmarked $452 million in federal funding through the ARP  funding to Health insurance program for efforts to lower costs and improve health insurance access in 13 states. Due to the changes made to the ARP, states with 1332 reinsurance waivers will have more […]
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how-ambulatory-surgery-centers-lower-payer-outpatient-spending

How Ambulatory Surgery Centers Lower Payer Outpatient Spending

Payers can reduce surgical costs by 59 percent by shifting eligible members from the hospital outpatient setting to ambulatory surgery centers. Ambulatory surgery centers are care sites that offer surgical procedures, diagnostics, and preventive care services, according to the Ambulatory Surgery Center Association. These sites are not provider offices, rural healthcare clinics, or urgent or […]
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cms-faces-calls-to-improve-remote-patient-monitoring-coverage-in-2022-pfs

CMS Faces Calls to Improve Remote Patient Monitoring Coverage in 2022 PFS

Telehealth advocates are submitting recommendations to CMS to improve coverage for remote patient monitoring services in the proposed 2022 Physician Fee Schedule. With remote patient monitoring projects surging in popularity as a result of the pandemic, telehealth advocates are lobbying the Centers for Medicare & Medicaid Services to improve proposed coverage plans in the 2022 […]
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2022 IPPS Final Rule Boosts Hospital Reimbursement

  On Aug. 2, 2021, the Centers for Medicare and Medicaid Services (CMS) posted the fiscal year (FY) 2022 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) final rule. Effective Oct. 1, the final rule updates Medicare payment policies and quality reporting programs for inpatient and long-term care hospitals […]
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cms-asks-medicare-advantage-plans-to-relax-prior-authorizations

CMS Asks Medicare Advantage Plans to Relax Prior Authorizations

  The agency emphasized relaxing prior authorizations that could impact transferrals between general acute-care hospitals and longer-term care facilities. CMS has requested that Medicare Advantage organizations relax or waive prior authorizations due to the impact of the coronavirus Delta variant. “The ability of hospitals to transfer patients to appropriate levels of care without unnecessary delays […]
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