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Worries About the Medicare Physician Fee Schedule Rule for 2021

By | Blog, healthcare management consulting, Nextgen EHR

Provider organizations are worried certain proposals in the 2021 Medicare Provider Fee Schedule regulation will worsen the financial difficulties doctors are currently experiencing during the COVID-19 pandemic, including the inadequacy of sufficient payment for telehealth and profits from sustainable practice. The legislation released in early August suggested several improvements to next year’s Medicare Physician Fee Plan, including steep rate increases for certain specialties, improvements to the list of telehealth services, and additional standards for accuracy monitoring.

Increasing relative value units (RVUs) and payment for primary care facilities and treatment of chronic disorders are the key proposals of the rule. However, the regulation also requires a drop in the payment exchange factor to $32.26 from $36.09 in order to offset the improvements to RVUs for the services.

Provider industry groups have encouraged CMS to beef up telehealth scope recommendations in the finalized version of next year’s Medicare Physician Fee Schedule. Several proposals that would increase telehealth coverage were included in the rule, including the inclusion of eight codes to the Category 1 list of telehealth providers and the development of a separate Category 3 list to extend provisional coverage.

Another leading issue affecting multiple provider groups was the tweak to quality reporting regarding the Quality Payment Program and other value-based reimbursement models. The substitution of the APM Scoring Standard with the current Alternative Payment Model Efficiency Pathway was largely opposed, particularly by provider groups.

To read more, please visit https://revcycleintelligence.com/news/top-3-concerns-with-the-2021-medicare-physician-fee-schedule-rule.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

CMS Releases 2021 Medicare Advantage Star Ratings

By | Blog, healthcare management consulting, Nextgen EHR

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) released its 2021 Medicare Advantage and Part D star ratings. Just over twenty health plans earned five stars, including familiar names like Cigna and CarePlus by Humana. Only four health plans had low ratings of 2.5 stars, and there were no plans with ratings below that.

The CMA star rating system began for Medicare Advantage plans in 2008 to monitor performance on selected criteria for beneficiaries. By 2012, those metrics were tied to payments and bonuses for quality incentives. On a scale of one to five stars, CMS rates Medicare Advantage health and drug plans, with one star indicating bad results and five stars meaning outstanding performance.

The new star ratings are good news for the more than one-third Medicare beneficiaries who choose a Medicare Advantage plan. Medicare Advantage premiums in 2021 will be the lowest since 2007. The average star rating has increased from 4.02 in 2017 to 4.06 in 2021, and, according to CMS, approximately 77% of beneficiaries enrolling in Medicare Advantage plans with drug coverage will participate in plans with four or more stars.

Up to 44 separate consistency and success metrics are classified for Medicare Advantage with Medicare Part D prescription drug coverage contracts, and up to 32 metrics are classified for Medicare Advantage-only contracts (without coverage for prescription drugs). No new measures have been introduced for 2021. However, CMS is taking into account patient comments and experiences more heavily, including the quality of care being received by the plans. The effect of the coronavirus on star ratings has been tracked by CMS and several improvements have been implemented to forestall the impact.

To read more, please visit https://www.healthcarefinancenews.com/news/21-medicare-advantage-plans-earn-5-stars-cms-release-star-ratings.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

CMS Shares COVID-19 Data Reporting Guidance

By | Blog, healthcare management consulting, MIPS consulting

CMS recently shared guidance on how it aims to enforce a recent temporary final rule mandating condition of participation (CoP) in Medicare for hospitals publishing COVID-19 results.

The guidelines issued earlier this week declared that, during the pandemic, hospitals risk Medicare termination should they fail to report daily on the more than 30 measures required by CMS. The metrics comprise regular COVID-19 admissions, including those affecting ventilated patients, fatalities from COVID-19, and other virus-related hospital utilization data.

Hospitals will now have to submit weekly supply-related metrics and also report new cases of influenza. This is presently voluntary but will become obligatory in November.

Beginning October 7, 2020, hospitals that do not meet the COVID-19 data reporting standards will be given a CMS warning. The hospitals will have three weeks to address any discrepancies in implementation, according to guidelines. Following these warnings, a second advisory alert will be given by CMS to hospitals failing to send out the required daily information.

In general, before being terminated from federal healthcare services, hospitals have a total of 14 weeks to meet Medicare CoP. These terminations would mean hospitals would not obtain payment for the treatment of recipients of Medicare and Medicaid.

To read more, please visit https://revcycleintelligence.com/news/cms-releases-guidance-on-covid-19-data-reporting-as-medicare-cop.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

South Florida Healthcare Practice Rises Early to the COVID-19 Challenge

By | Blog, healthcare management consulting

As the coronavirus made its way to South Florida, CareMax Medical Centers was already adjusting its healthcare delivery model to face the challenges practices would soon need to address. CareMax partnered with CareOptimize early on to help proactively address COVID-19 challenges with productive responses. Within three days, the team implemented several policies and procedures to ensure staff and members stayed safe. Many of these have now been made permanent.

CareMax began offering its members virtual appointments before telehealth gained widespread use, enabling CareMax physicians to remain completely available to members. For those members who do not have a computer or may be technologically challenged, CareMax Transportation drivers take tablets to members’ homes, so they can participate in a virtual visit.

Using the CareOptimize service-as-software platform “HeartBeat,” providers have information on all members to facilitate clinical decisions as well as continue to track members with chronic issues, alleviating problems inherent with prolonged breaks in care.  All patients identified as positive or suspected COVID-19 cases are kept on a frequently updated list. Physicians give daily virtual video visits to every single one of these patients to monitor their progress. Anyone admitted to a hospital receives a virtual visit immediately afterward and, if appropriate, an in-home visit from a CareMax home health nurse.

To ensure constant communication, every member receives a weekly wellness check phone call to ensure they are well, continuing safe habits, and maintaining a proper diet. Should there be an issue, members can request a virtual visit with a provider or a visit from a home health nurse.

To keep costs down and better assist those that need attention, the “Call CareMax First” campaign was developed to encourage members to contact CareMax before heading to a hospital. This simple procedure has helped prevent unnecessary hospital visits, while allowing members to connect with a medical professional at all hours of the day, every day of the week.

COVID19 has forced the healthcare industry to rethink the way things are done. Thinking outside the box is something CareOptimize has always done for each and every one of their clients. The challenges continue, so do the solutions.

To read more about CareMax Medical Centers, please visit https://www.prnewswire.com/news-releases/healthcare-with-heart-is-more-than-a-slogan-at-caremax-301143889.html.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR

Advance Medicare Payment Relief Is on the Way

By | Blog, healthcare management consulting, MIPS consulting

Near the onset of the pandemic, many clinicians received advanced Medicare payments through CMS’ Medicare Accelerated and Advance Payment Program. The repayment of those funds was recently extended from 210 days to an entire year as part of a resolution recently signed by President Trump, which includes several healthcare-specific provisions.

The Accelerated and Advance Payment Program was instituted when the sharp decline in admissions and visits hospitals and other services were experiencing due to COVID19 became problematic.

Through the program, CMS advances expected Medicare reimbursement and eventually recoups it. Recoupment usually begins 120 days after receipt of the initial payment. That term was extended to 210 days for the pandemic. The recently signed legislation will grant providers a year until CMS will begin reclaiming the disbursements.

For the first eleven months of recovery, CMS is only allowed to offset a provider’s cost by 25 percent. That rises to 50 percent for the following six months. CMS will postpone Medicare reimbursement for 29 months from the date of the first payment under the initiative.

The bill is a victory for caregivers who, given the current public health emergency, have been pressing on lawmakers to grant them more attractive reimbursement terms.

To read more, please visit https://revcycleintelligence.com/news/lawmakers-provide-accelerated-advance-medicare-payment-relief.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

EHR Plays a Role in Value-Based Hospice Care

By | Blog, healthcare management consulting, MIPS consulting

As healthcare transitions towards value-based care, electronic health record (EHR) systems are gradually adding functionality to specifically target providers of end of life and acutely ill care. In order to remain competitive in a packed marketplace and provide data-powered reporting for regulatory obligations, numerous hospice and palliative care providers have stepped up efforts to incorporate electronic systems.

With capabilities to handle treatment plans, prescriptions, and workflows off-site, EHR systems can supply scheduling capabilities for patient intake and continuing visits and evaluations amid hospice clinical and operational teams. To minimize industry-wide worker mental collapse and employee shortfalls, workflow enhancement has been crucial. Electronic analysis of the hospice-specific billing code is an extra function of certain electronic health record-keeping systems to improve productivity and decrease time used on long documentation procedures.

Taking advantage of EHR capabilities may also allow proactive detection of patients who might benefit from severe illness and end of life treatment, facilitating standardized usage of evidence-based screening and evaluation methods. Care coordinators can make use of clinical data to better the quality of reporting, determine the effectiveness of treatment, and enable process and outcome measures to easily extract data.

For more information on our Nextgen EHR products, please visit https://careoptimize.com/products/. This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

CMS Is Making Medicare Advantage Risk Adjustment Changes

By | Blog, healthcare management consulting, Nextgen EHR

CMS recently proposed changes to Medicare Advantage and Part D payments for 2022, finalizing a multi-year phase-in of a novel, controversial payment method where plan risk scores are based entirely on encounter data.

In the past, to complement encounter information in calculating payment, CMS has relied on reports submitted through its Risk Adjustment Processing System (RAPS) method but stated that policy would cease in 2022.

Risk scores reflect a beneficiary’s estimated medical expenses and are utilized in tailoring Medicare Advantage plan federal payments. In general, the more ill an individual is, the greater the risk score and, therefore, the greater the payment earned by an MA plan. CMS began collecting encounter data, or data based on claims data generated by a provider, supplier, physician in a practice or hospital setting, in 2012. According to insurers, this data can often be incomplete or inconsistent, so depending entirely on that data for risk scores could potentially lower federal plan payments.

As mandated by the 21st Century Cures Act, CMS will completely transition to this risk adjustment calculation model that has been slowly increasing since 2016, when encounter data made up 10% of a risk score. In 2019, 25% of risk adjustment scores were based on encounter data, and that number increased to 75% in 2021. In 2022, encounter data will be the sole determinant for calculating risk adjustment.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

Optimize Your Clinic With a Patient Tracking System

By | Blog, healthcare management consulting, MIPS consulting, Patient Tracking System

Ambulatory care surgical centers and urgent care clinics often grapple with numerous patients and clinical activity that need consistent tracking. Failure to streamline the process may affect the efficiency of the clinic or healthcare practice which, in turn, can lead to serious consequences. Greater wait times mean more disgruntled patients and stressed staff and providers. Increased wait times may also endanger a patient’s condition, requiring emergent care.

CareOptimize has developed a solution. Our Patient Tracking System helps clinics and surgical centers keep track of all clinical activity in real-time, boosting operational efficiency and ensuring better patient and provider satisfaction.

The Patient Tracking display is designed to be user-friendly and can be displayed on screens of various sizes. With this tool, the clinical staff is always aware of the location of each patient and provider on your floor plan and the degree of acuity and clinical actions for each case. Furthermore, the tool shows the average and longest wait time, plus the number of patients waiting to be seen, providing the right data to allow concentration of efforts to reduce wait times while, at the same time, offering optimal care.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

Medicare MIPS Continues During the Pandemic

By | Blog, healthcare management consulting, managed care solutions

The Centers for Medicare & Medicaid Services (CMS) recently announced that healthcare groups and physicians have until the 5th of October to contest their success score for their 2019 Merit-based Incentive Payment System (MIPS) if they disagree with the amount reported by the Centers for Medicare & Medicaid Services.

CMS recently posted success ratings on the website of the Quality Payment Program (QPP) for physicians and those involved in MIPS, which can be accessed through the portal. The score governs 2021 Medicare payments to doctors and healthcare organizations, who are given an adjustment that’s either positive, negative, or neutral.

MIPS-eligible physicians, associations, and virtual entities — including those who engage in an alternative payment model (APM)—can request a summary by visiting the QPP website.

It is necessary for physicians and groups to review their 2019 performance feedback reports and 2021 payment adjustment scores for accuracy. As a result of the pandemic, CMS introduced a policy aimed at keeping physicians harmless from payment changes if they did not apply 2019 MIPS data.

CMS has also announced the option of opting out of the 2020 MIPS program in full or in part. In order to do so, a request for hardship on the QPP website must be made before December 31, showing the hardship is tied to the pandemic.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.