Tag: Medicare RCM

The Clock Is Ticking: HIPAA Small Breach Notifications Due March 1st

March 1, 2022, is the date by which HIPAA-covered entities must notify the U.S. Department of Health and Human Services Office for Civil Rights (OCR) of “small” breaches of unsecured protected health information that were discovered during calendar-year 2021. A small breach involves fewer than 500 individuals. HIPAA Small Breach Notification Requirements HIPAA requires covered […]
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Telehealth use in Medicare increased 63-fold last year with behavioural health increasing the most

The number of beneficiaries in traditional Medicare using telehealth exploded 63-fold in 2020 from 840,000 in 2019 to nearly 52.7 million, a new study found. The study, released Friday (PDF) by the Department of Health and Human Services (HHS), comes as advocates are pressing to make key flexibilities the federal government enabled at the start […]
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Medicare Advantage Plans and the Two-Midnight Rule

Medicare Advantage plans hold up their end of the contract with CMS, and provide, at a minimum, a fair reimbursement for services delivered. The physician advisor is a fast-growing specialty that has evolved into so much more than someone who performs endless chart reviews for observation status determinations, medical necessity reviews, peer-to-peer conversations with payors, […]
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What are the Costs and Benefits of Medicare Audits?

For most readers the results of this analysis will be amazing but true. Longtime RACmonitor contributor and R1 Physician Advisory Services Vice President Dr. Ronald Hirsch recently pointed site Publisher Chuck Buck in the direction of something that, frankly, wowed him: a PhD thesis from a young Columbia University student on the topic of the […]
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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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Optum partners with SSM Health and will employ certain revenue cycle staff

To reduce care variation, SSM and Optum will use clinical technologies, advanced analytic and data-driven insights at the point of care. Certain SSM Health revenue cycle staff and hospital care management will become employees of Optum. They will continue to work in their current locations across Illinois, Missouri, Oklahoma and Wisconsin. WHY THIS MATTERS As […]
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87 Contracts Score 5 Stars on 2022 Medicare Advantage Star Ratings

On average, Medicare Advantage-prescription drug plans scored 4.37 stars for the 2022 Medicare Advantage Star Ratings. Over nine in ten Medicare Advantage-prescription drug plans (94.26 percent) received a 3.5 star rating or higher on the 2022 Medicare Advantage Star Ratings, with an average star rating of 4.37 stars, CMS announced. In contrast, in 2019 over […]
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Medicare Advantage COVID-19 Hospitalizations Were Lower Than FFS

Medicare Advantage coronavirus-related hospitalizations were lower than fee-for-service  Medicare’s rates from January through November 2020, a Better Medicare Alliance report found. ATI Advisory compiled the report on behalf of Better Medicare Alliance using data from the MCBS Fall 2020 Community Supplement Public Use Files and Medicare Claims Data. Overall, Medicare beneficiaries experienced hospitalization for coronavirus […]
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Hospitals And Health Systems Projected To Lose About $54B In Net Income In 2021

Sicker patients, fewer outpatient visits, and higher expenses for labor, drugs, and supplies will continue to damage the financial health of hospitals and health systems throughout 2021, says a new analysis released today by the American Hospital Association (AHA). Hospitals nationwide will lose about $54 billion in net income over the course of the year, […]
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The CMS repeals rule allowing coverage of breakthrough technologies for Medicare patients

CMS is exploring a new rule due to concerns raised and operational challenges. The rule that would have allowed access to Food and Drug Administration-designated and -approved technologies for Medicare patients suffering from illnesses and conditions that existing treatments and technologies are unable to address. CMS is exploring a new rule due to concerns raised […]
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