CareHarmony’s Post

Mitigating Leakage Under Primary Care First… All practices that participate in CMS’ Primary Care First (PCF) model have financial penalties assessed each quarter by CMS. These leakage penalties can result in significant reductions to the capitation payments practices receive. However, even a modest reduction in leakage visits can generate tens of thousands of dollars (or more) of additional revenue each quarter. Want to know how? Learn more here: https://okt.to/DrBYhm #PrimaryCareFirst

Great insight into these changes.

Infographic: 8 Questions FQHCs Should Ask Before Starting an #RPM Program. Plus, a comprehensive list of FQHC requirements for #remotepatientmonitoring including what an RPM program should include - https://hubs.la/Q02845hC0

What are the the financial mechanics of CMS’s new Making Care Primary (MCP) payment model? CMS’s new primary care centered innovation model offers a three-track approach to offering flexibility to providers with varying levels of value-based care experience. We've unpacked some of the financial details in the chart below that providers should be laser focused on in the coming months. CMS will release the request for application in August 2023. Stay tuned for further specifics surrounding some of these payment mechanisms. #OWActuarial #MakingCarePrimary #CMS

Excited to share that Humana will implement code editing rules🥳 Please refer to the source link; it's excellent and provides suggestions for modifiers, MUE/ maximum allowed units, physician qualifications required, and conditions for reimbursement. These coding edits promise to streamline processes and ensure compliance for fellow coders. Initial code editing rules for the Oklahoma Medicaid implementation: Humana will apply the code editing rules listed in this document to Oklahoma Medicaid claims submitted to Humana for dates of service beginning April 1, 2024. These code editing rules will be applied on the first day this plan is in effect. How to submit questions about a specific code editing rule You can submit questions about code edits through our code-editing questions tool on Availity Portal. If you are not registered on Availity: 1. Go to Availity.com and select “REGISTER” to sign up. 2. Once logged in, select the “More” tab. 3. Under the “Claims” heading, select the “Research Procedure Code Edits” link to access the tool. If you do not see this link, contact your Availity administrator to request access. 📚Source: https://lnkd.in/gnyDvuT5 #humana #payerupdates #ama #icd10 #cpt #stayinformed #knowledgesharing #letsconnect #availity #2024vision

Surprisingly, about half of HSG Advisors recent provider compensation survey respondents (48%) said they were unsure if the 2023 inpatient coding and documentation changes will impact their providers’ coding curves and compensation. This digital guide presents a straightforward approach to better understanding the coding and documentation changes and their potential impacts: https://lnkd.in/eapvbfF4 #compensation #compliance #2023inpatientcoding #survey #healthcareconsulting

2024 MPFS is here! I'll admit, I was more apprehensive about this one than I have been in previous years. A few proposals in the proposed rule stood to have a major cooling effect on remote monitoring depending on how CMS ultimately ruled. I'm thrilled to say those fears were quelled this morning! Here's what I am excited about: • FQHCs and RHCs can bill HCPCS code G0511 multiple times per month to account for multiple care management services provided to patients. The rule does not appear to establish a maximum number of times the code may be billed. • Practitioners receiving a global service payment may separately bill for RPM and RTM for underlying conditions not directly linked to the global procedure. • Practitioners who did not perform the global service and do not receive a global payment (e.g. PTs, OTs) may bill for RPM or RTM for any condition within their scope of practice. • CMS officially confirmed (finally!) what we already knew: the 16-day requirement does NOT apply to CPT codes 99457, 99458, 98980, or 98981. #remotemonitoring #MPFS2024 #RPM #RTM #digitalhealth Shoutout to the team that's always the first to know this stuff: Carrie Nixon Rebecca E. Gwilt Aizaz Chaudhary Reema Taneja Stephanie Barnes Sam Pinson Michael Schellhous Nixon Gwilt Law Link to PDF of the Final Rule: https://lnkd.in/e_QkHcFj

After the extensive changes CPT® made to the evaluation and management (E/M) codes and guidelines over the last few years, you’ll be relieved to know that the E/M changes in CPT® 2024 are minimal. Read more on our blog: https://hubs.la/Q023g7ts0 #cpt #evaluationandmanagement #codechanges