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All posts tagged with “Regulatory News | Medicare.”
Medicare Hospice – exploding in size but riddled with quality concerns
03/11/24 at 03:00 AMMedicare Hospice – exploding in size but riddled with quality concerns Penn LDI, by Hoag Levins; 3/8/24 Five top experts on hospice care convened in a virtual discussion of the Medicare Hospice program. This video is the full session.
The states where most Medicare beneficiaries have Medicare Advantage plans
03/11/24 at 03:00 AMThe states where most Medicare beneficiaries have Medicare Advantage plans Becker's Payer Issues, by Andrew Cass; 3/6/24 Twenty-six states now have more than half of their Medicare enrollees in Medicare Advantage plans, according to a March 5 report from Chartis, a healthcare advisory services firm. Nationwide, half of Medicare-eligible beneficiaries are now enrolled in Medicare Advantage plans. [Click on the title's link for] the 26 states where Medicare Advantage market penetration exceeds 50%.
Frontline hospice staff need to understand new CMS survey methods
03/11/24 at 02:00 AMFrontline hospice staff need to understand new CMS survey methodsHospice News, by Holly Vossel; 3/5/24Ensuring staff are educated around revisions to hospice survey processes will be key to navigating ongoing regulatory changes in the industry. This year will bring further implementation of survey validation activities, but also new regulatory oversight processes, according to Kim Skehan, vice president of accreditation for the Community Health Accreditation Partner (CHAP) organization.
CMS to end Hospice MA Carve-In: Insights for home-based care providers
03/11/24 at 02:00 AMCMS to end Hospice MA Carve-In: Insights for home-based care providers Home Health Care News, by Andrew Donlan; 3/7/24Grand opening, grand closing. Hospice providers began to work with Medicare Advantage (MA) via the Value-Based Insurance Design (VBID) demonstration in 2021. At the end of 2024, the “hospice carve-in” model will cease. ... In this week’s exclusive, members-only HHCN+ Update, I dive into what CMS’ ditching of the hospice carve-in means for home health and hospice providers generally. I’ll also get into what it may mean for that space between home-based care providers and MA plans moving forward.
House-passed funding bill makes Medicare hospice benefit a ‘piggybank,’ provider groups argue
03/08/24 at 03:00 AMHouse-passed funding bill makes Medicare hospice benefit a ‘piggybank,’ provider groups argue McKnights Home Care, by Adam Healy; 3/7/24 To keep the government open in fiscal year 2024, hospice partially may be bankrolling it — and providers are not pleased about this prospect. The House late Wednesday passed a newly released appropriations bill that includes an extension of the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). This act which would effectively allow the Medicare hospice benefit to act as a pay-for for nonhospice legislative priorities.
Wound coding changes bring compliance, legal questions
03/07/24 at 03:30 AMWound coding changes bring compliance, legal questions McKnights Long-Term Care News, by Josh Henreckson; 3/5/24 Changes to end-of-life wound classification in a recent Minimum Data Set update should be a positive for long-term care, but regulatory and legal ambiguity still surrounded the new coding procedures at press time.
MA’s cost-management tools may be hurting home healthcare quality, outcomes
03/07/24 at 03:00 AMMA’s cost-management tools may be hurting home healthcare quality, outcomesMcKnights Long-Term Care News, by Adam Healy; 3/5/24Medicare Advantage’s use of cost-reducing tools such as copays, prior authorizations and restricted provider networks may be preventing home healthcare providers from delivering higher-quality care, according to one home healthcare leader.
CMS offers relief to providers affected by Change Healthcare outage
03/07/24 at 03:00 AMCMS offers relief to providers affected by Change Healthcare outageModern Healthcare, by Lauren Berryman; 3/5/24The Centers for Medicare and Medicaid Services has rolled out efforts to help providers navigate the Change Healthcare outage disrupting healthcare operations nationwide, the Health and Human Services Department announced Tuesday.Editor's Note: Access to the full article requires a subscription
Hospices welcome VBID’s demise, but questions remain
03/07/24 at 02:00 AMHospices welcome VBID’s demise, but questions remainHospice News, by Jim Parker; 3/5/24Citing “operational challenges,” the U.S. Centers for Medicare & Medicaid Services (CMS) announced [Monday] that it would bring to a close the hospice component of the value-based insurance design (VBID) demonstration, effective Dec. 31. ... Hospice News spoke with leaders of hospice organizations, industry groups and other stakeholders to gauge providers’ perceptions of the CMS decision.
Ounce of prevention: Is a selling hospice or home health agency ready for the 36-Month Rule?
03/06/24 at 03:00 AMOunce of prevention: Is a selling hospice or home health agency ready for the 36-Month Rule? McGuire Woods; 3/4/24Medicare-enrolled hospices and HHAsshould take the following steps toassess and avoid triggering the 36-month rule: [click on the link for content]
The top strategies healthcare organizations can use to reduce denials
03/06/24 at 03:00 AMThe top strategies healthcare organizations can use to reduce denials MedCityNews, by Laxmi Patel; 3/5/24Here are six actionable steps healthcare organizations can take to reduce their likelihood of denials and write-offs.
Veterans’ care new battleground in nursing home staffing mandate
03/06/24 at 03:00 AMVeterans’ care new battleground in nursing home staffing mandate McKnights Long-Term Care News, by Kimberly Marselas; 3/5/24Two senators have introduced a bill to determine exactly what “unintended circumstances” could result for elderly veterans if a federal rule mandating staffing levels at all US nursing homes is allowed to proceed. ... The bill would require the VA to study potential risks associated with the proposed Center for Medicare and Medicaid Services rule — especially as they pertain to rural providers. The senators said the proposal would “unsustainably change staffing ratios at nursing homes.”
Coverage denials in Medicare Advantage—Balancing access and efficiency
03/06/24 at 03:00 AMCoverage denials in Medicare Advantage—Balancing access and efficiencyJAMA Health Forum; by Suhas Gondi, MD, MBA; Kushal T. Kadakia, MSc; and Thomas C. Tsai, MD, MPH; 3/1/24 Each year, millions of claims for medical services are denied by health insurance plans. Many denials may be justified as a necessary strategy to reduce wasteful spending from low-value care. However, denials may also delay diagnosis and/or treatment for patients, and appealing denials contributes to clinician workload and burnout. This tension is apparent in the Medicare program, where denials affect millions of beneficiaries who enroll in Medicare Advantage (MA).
Congress floats Medicare physician pay bump: 4 notes
03/05/24 at 03:30 AMCongress floats Medicare physician pay bump: 4 notes Becker's Hospital CFO Report, by Mackenzie Bean; 3/4/24 Physicians are set to receive a 1.7% increase in Medicare pay effective March 9 as part of a $460 billion spending package congressional leaders released this weekend. Four things to know: ... [click on the title's link for more]
Premier Hospice Phoenix exits Medicare program, impacting local healthcare
03/05/24 at 03:00 AMPremier Hospice Phoenix exits Medicare program, impacting local healthcareBNN, by Mazhar Abbas; 3/4/24Premier Hospice in Phoenix ends its Medicare agreement, sparking concerns among patients and providers. Explore the impact and future of hospice care.
The Future of the Hospice Benefit Component of the Value-Based Insurance Design (VBID) Model
03/05/24 at 02:00 AMThe Future of the Hospice Benefit Component of the Value-Based Insurance Design (VBID) ModelCMS website; 3/4/24Beginning in Calendar Year (CY) 2021, the Value-Based Insurance Design (VBID) Model allowed participating Medicare Advantage Organizations (MAOs) to include the Medicare hospice benefit in their Medicare Advantage (MA) benefits package, herein known as the Hospice Benefit Component. After carefully considering recent feedback about the increasing operational challenges of the Hospice Benefit Component and limited and decreasing participation among MAOs that may impact a thorough evaluation, CMS has decided to conclude the Hospice Benefit Component as of December 31, 2024, 11:59 PM. CMS will not accept applications to the previously released CY 2025 Request for Applications for the Hospice Benefit Component of the VBID Model.
Home health disparities: Medicare Advantage patients receive fewer visits, worse outcomes
03/05/24 at 02:00 AMHome health disparities: Medicare Advantage patients receive fewer visits, worse outcomes Home Health Care News, by Patirck Filbin; 3/1/24Home health patients under Medicare Advantage (MA) plans have worse functional outcomes compared to traditional Medicare patients, likely as a result of receiving fewer visits, according to a new study.
What the UnitedHealth Group Antitrust Investigation means for Amedisys, home health industry
03/04/24 at 03:00 AMWhat the UnitedHealth Group Antitrust Investigation means for Amedisys, home health industry Home Health Care News, by Andrew Donlan; 3/1/24 Since the news surfaced Tuesday that the Department of Justice had opened an antitrust investigation into UnitedHealth Group (NYSE: UNH), additional questions have bubbled up. Namely, those questions surround the home health provider Amedisys Inc. (Nasdaq: AMED), which agreed to be acquired by UnitedHealth Group’s Optum in June of last year.
‘Playbook’ offers strategies for home health, hospice firms to jump into value-based care
03/04/24 at 03:00 AM‘Playbook’ offers strategies for home health, hospice firms to jump into value-based care McKnights Home Care, by Adam Healy; 2/28/24 Don’t drag your feet. As entities like Medicare Advantage and Accountable Care Organizations continue to grow and thrive, the time is now for home care to step into value-based care, according to home care consultants at Transcend Strategy Group. “The next two or three years are going to be very critical,” Tony Kudner, chief strategy officer at healthcare consultancy firm Transcend Strategy Group, said in an interview Tuesday with McKnight’s Home Care Daily Pulse. “Now is the time to build out the larger organizational competencies that value-based care is going to require.”
CMS upends Medicare Advantage supplemental benefits data reporting for payers
03/04/24 at 02:00 AMCMS upends Medicare Advantage supplemental benefits data reporting for payers DLA Piper, by Daivd Kopans and Sua Yoon; 2/27/24 On February 21, 2024, the Centers for Medicare & Medicaid Services (CMS) issued new guidance via a memorandum to Medicare Advantage (MA) organizations, Program of All-Inclusive Care for the Elderly (PACE) organizations, and Demonstration Organizations (collectively, Plans) that upends how these Plans have been reporting (or not reporting) encounter information for their covered supplemental benefits. The guidance in the memorandum is effective retroactively to January 1, 2024. [In this article] is a Q&A explaining the top points of the guidance and highlight its impact on companies across industries.
The devil’s in the details: Hospice providers face Claim Denials for Election Statement technicalities
03/01/24 at 03:00 AMThe devil’s in the details: Hospice providers face Claim Denials for Election Statement technicalities JDSupra, by Lanchi Nguyen Bombalier and Charmaine Mech; 2/29/24Since the Centers for Medicare & Medicaid Services (“CMS”) paused much of its audit activity during the COVID Public Health Emergency, the most recent rounds of Medicare audit activity may represent the first “look” at the new Election Statement forms that many hospice providers adopted under the new Medicare election statement requirements effective in October 2020. Unfortunately, these initial audit results from the Medicare Administrative Contractors (“MACs”) suggest that hospice providers and MAC reviewers may not necessarily see eye-to-eye on what information must be included in the new Election Statement.
Untangling the history, causes behind the precipitous home health aide utilization drop
03/01/24 at 03:00 AMUntangling the history, causes behind the precipitous home health aide utilization drop Home Health Care News, by Patrick Filbin; 2/28/24In the last home health proposed rule from the Centers for Medicare & Medicaid Services (CMS), the federal agency in charge of reimbursement rates sent out a request for information on home health aide utilization. Specifically, the agency wondered why Medicare-covered home health aide visits and utilization had fallen off a cliff over the last few decades. According to the Center for Medicare Advocacy, home health aide visits declined by 90% from 1998 to 2019.
False Claims Act - 2023 Year in Review
03/01/24 at 03:00 AMFalse Claims Act - 2023 Year in ReviewJD Supra; by William Athanas, A. Lee Bentley III, Gene Besen, Ryan Dean, Jonathan Ferry, Daniel Fortune, Giovanni Giarratana, Ty Howard, Elisha Kobre, Anna Lashley, Gregory Marshall, Lyndsay Medlin, Stephen Moulton, Ocasha Musah, Scarlett Singleton Nokes, Cara Rice, Brad Robertson, Tara Sarosiek, Jack Selden, Erin Sullivan, Courtlyn Ward, Virginia Wright; 2/28/24As we do every year, this issue revisits the key cases and other developments from the year gone by. And by most metrics, 2023 was a notable year for the False Claims Act (FCA).
The Medicare Care Choices Model was associated with reductions in disparities in the use of hospice care for Medicare beneficiaries with terminal illness.
03/01/24 at 03:00 AMThe Medicare Care Choices Model was associated with reductions in disparities in the use of hospice care for Medicare beneficiaries with terminal illnessHealth Serv Res by Matthew J Niedzwiecki, Lauren Vollmer Forrow, Jonathan Gellar, R Vincent Pohl, Arnold Chen, Lynn Miescier, Keith Kranker; 2/29/24 Conclusions: Medicare Choices Model (MCCM) increased hospice use and quality of end-of-life care for model enrollees from underserved groups and reduced disparities in hospice use and having multiple emergency department visits.