Centers for Medicare and Medicaid Services (CMS)-
The CMS recently postponed the release of the latest star rankings for hospitals due to pressure from lobbyists. The rating was due to launch on Friday 4/22, and now plans are to release them in July. The new star rating is meant to simplify hospital care scores, but questions about the methodology caused push back from congressional and industry insiders.
A couple of new programs by the CMS will be launching soon. One ensures Medicaid enrollees and children receive the same level of benefits for mental health or substance abuse treatment as they receive for medical and surgical care. Another program hopes to boost healthcare savings by bundling payments for certain joint replacement surgeries and procedures and basing payments on average regional costs. A recent program by the CMS designed to help people at risk for diabetes was shown to improve participants’ health and save on healthcare costs. The program involves weekly training sessions on nutrition, exercise, and healthy living, and participants who attended at least 4 sessions showed a weight reduction of about 5%, lowering their risk for diabetes. One more initiative by the CMS that will be implemented soon is the Comprehensive Primary Care Plus (CPC+) Program. This program benefits patients and doctors by paying doctors for achieving results and improving care, and allows them to care for their patients the way they think is best.
Affordable Care Act Marketplace
The current state of the ACA Marketplace Exchange is changing, with UnitedHealth announcing plans to pull out of most exchanges after an expected loss of $1 billion, while Cigna plans to expand into more. Health insurer Anthem announced a new provider-insurer alliance with Wisconsin’s Aurora Health Care system. Blue Cross Blue Shield is evaluating “all options” on whether it will remain in the Marketplace.
The overall opinion of the transition to ICD-10 seems to be positive, with few to little reports of catastrophic problems. The CMS has several links to assist those who might need it, offering a code lookup tool, and several downloads to assist with coding.
Electronic Health Records
Recent ransomware virus attacks have made headlines across the nation, with 10 hospitals in the MedStar Health System in Washington DC being crippled by an attack, including Georgetown University Hospital. The attack prevented employees from being able to access patient records or email. A month prior, a Los Angeles hospital paid $17k to hackers to regain access to their system. Attacks of this nature are only increasing in frequency, and health systems should be taking steps to prevent them while also developing plans for if an attack does happen.
To further assist you in your contracting efforts, please click our free whitepaper here about 3 techniques to analyze and increase your reimbursements. You have nothing to lose, it is free and will help you. If you would like to discuss your payer contracts, please send me an email and I’ll be happy to assist. For more information, please contact: Steve Selbst, email@example.com or 831-455-2174. For general information or questions, please phone us at 1-800-497-4970 or send an email anytime to firstname.lastname@example.org. We look forward to hearing from you and are glad to provide information that helps you as a provider to run a more profitable practice / company.