CMS released a proposed rule this week that would boost hospitals’ inpatient payment rates by 2.6%. Hospitals groups have swiftly denounced this plan, arguing that this payment update is insufficient and will jeopardize hospitals’ financial stability.
In a webinar on April 16 at 1pm ET, Aneesh Chopra will moderate a discussion with executives from DocuSign, Velatura, and behavioral health providers on eConsent, health information exchange and compliance with the CMS Final Rule on interoperability.
Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.
America’s Health Insurance Plans, the Better Medicare Alliance and the Association for Community Affiliated Plans all came out against CMS’ final 2025 Medicare Advantage and Part D rate announcement.
Performance on these test calls impacts the organization’s Star Rating, which is a marker of plan quality published on the Medicare Pathfinder. A lower rating can mean the loss of millions of dollars in reimbursements.
Most hospitals and payers have publicly posted their pricing information, but experts think that data will remain mostly useless for consumers for at least another five years. Now that the data is available, healthcare software companies must step in and build tools that are personalized and easy to use. That way, consumers can eventually use price transparency data to shop for care.
Based on the risk profiles of orthopaedic operations, a shoulder replacement is actually safer than that of a hip or knee and therefore an ideal candidate for the ambulatory surgical center environment.
At the Abarca Forward conference earlier this year, George Van Antwerp, managing director at Deloitte, discussed how social determinants of health and a personalized member experience can improve medication adherence and health outcomes.
Several recent developments signal increased support for psychological assessments and treatments.
CMS finalized a rule on Wednesday that included set deadlines for affected payers to complete prior authorization requests. Several organizations came out in support of the rule.
Hospitals markedly improved their compliance with price transparency regulations in 2023, according to a new report. It found that more than 90% of hospitals have posted a machine-readable file containing gross charges, negotiated charges and cash prices for the services and items they provide.
HHS announced a new care model that aims to provide mothers with Medicaid coverage with more personalized maternal health care. This includes access to doulas and midwives and screening for health-related social needs.
We will highlight Build My Health's revenue practice management tools, which could help physician practices add up to $250,000 to their practices.
The mandates set the framework and data requirements for transparency but consumers need more guidance for informed decision-making and comparisons. Health plans should be acting now to turn the conversation from compliance to true member engagement.
In a letter to CMS, four senators asked for better data collection on the practices of Medicare Advantage plans, including when it comes to prior authorization.
Of those who have chosen ACA Marketplace coverage so far in the 2024 Open Enrollment Period, 20% are new consumers and 80% are returning consumers, according to CMS.
GUIDE — Guiding an Improved Dementia Experience — is the new dementia care model from the CMS and the CMMI (Centers for Medicare and Medicaid Innovation) for beneficiaries covered by traditional fee-for-service (FFS) Medicare and their caregivers. It represents an incremental step forward in managing neurodegenerative diseases effectively.
CMS proposed a new rule that would set a flat amount — $632 — that MA plans can pay agents and brokers when they help enroll a person into any MA plan. The proposed rule also addresses behavioral health access and prior authorization.