Category: Revenue Cycle Management

Direct-to-Consumer Telehealth Platforms Lag Behind Competition

Direct-to-Consumer Telehealth Platforms Lag Behind Competition

  The pandemic has changed patients’ use and perceptions of healthcare organizations. The question remains: Will those changes here to stay? PATIENTS PREFER TELEHEALTH SERVICES FROM DOCTORS, HEALTH PLANS Most telehealth users accessed virtual care services through their regular doctor or health plan as opposed to direct-to-consumer telehealth platforms, according to new data from Morning […]
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Providers Share Benefits of Medicare Advantage During COVID-19

Providers Share Benefits of Medicare Advantage During COVID-19

Providers’ experiences with Medicare Advantage plans’ capitated payment models, supplemental benefits, and overall influence gave them recommendations for CMS. There has been a lot of valuable conversation around the benefits that Medicare Advantage health plans can offer to consumers, but now providers have offered their perspectives on this form of health insurance in Better Medicare […]
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CMS Releases Physician Fee Schedule Final Rule

CMS Releases Physician Fee Schedule Final Rule

  CMS says it the goal is to support health equity while focusing on high-quality person-centered care. Increased leverage of telehealth for behavioral care, diabetes prevention and mitigation, and enhanced payment for vaccine administration were three out of many priorities cited by federal officials who announced the release of the Centers for Medicare & Medicaid […]
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The Role of Provider-Sponsored Health Plans in Value-Based Care

The Role of Provider-Sponsored Health Plans in Value-Based Care

Provider-sponsored health plans can be naturally aligned with value-based care goals while also being attuned to providers’ needs. Providence Health Assurance’s Medicare Advantage provider-sponsored health plan received a five-star rating through the CMS Medicare Advantage Star Ratings system for the 2022 Medicare open enrollment season. The health plan, which serves Oregon and Washington State, is […]
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CMS Updates End-Stage Renal Disease APM, PPS to Address Health Equity

CMS Updates End-Stage Renal Disease APM, PPS to Address Health Equity

The End-Stage Renal Disease (ESRD) Treatment Choices Model is the first to undergo changes to directly address health equity—a new goal for CMS-run alternative payment models. The ESRD Treatment Choices (ETC) Model is a mandatory alternative payment model (APM) that encourages greater utilization of home dialysis and kidney transplants for Medicare beneficiaries with the chronic […]
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Medicare drops end-stage renal disease payment rule that aims to close health equity gaps

The Biden administration dropped a final rule Friday that will reward providers that improve rates of home dialysis and kidney transplants among low-income Medicare and dual-eligible beneficiaries. The goal of the changes is to encourage dialysis providers to decrease disparities in home dialysis and transplant rates, part of a larger effort by the Biden administration. […]
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AHA Calls for Medicare Advantage Inclusion in Prior Authorization Rule

AHA Calls for Medicare Advantage Inclusion in Prior Authorization Rule

The American Hospital Association (AHA) has asked CMS to include Medicare Advantage organizations in its proposed rule that would streamline the prior authorization process and reduce patient care delays. In December 2020, CMS released a notice of proposed rulemaking about improving prior authorization, following past administrative and clinician struggles. If the rule is finalized, there […]
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2022 Medicare Advantage Plan Overview, Part Three_ Social Determinants

2022 Medicare Advantage Plan Overview, Part Three: Social Determinants

  “Medicare Advantage plans have a unique and growing opportunity to address the needs of socioeconomically vulnerable populations and improve their health,” reports America’s Health Insurance Plans. More plans for individuals with low incomes, as well as targeted SDOH investments and initiatives, round out carrier approaches. On the benefits side, offerings such as meals, transportation, […]
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More Medicare Advantage plans will offer nonmedical benefits in 2022, finds Avalere

More Medicare Advantage plans will offer nonmedical benefits in 2022, finds Avalere

  More plans will offer meals, nutrition, transportation or in-home support services at a $0 premium in 2022. Ahead of the annual election period, which began on October 15, the Centers for Medicare and Medicaid Services published information on MA and Part D plan (PDP) premiums, benefit offerings and star ratings. Avalere analyzed that data […]
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