Shadow bundles represent a novel way of structuring payments within an ACO’s attributed population. Starting in February of 2024, CMS now released detailed episode-level claims files, target prices, and summary reports on a monthly, quarterly, and annual basis. Read more: https://lnkd.in/gRDUJWkR #ACOs #SharedSavings #CMS
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CMS' proposed changes to the No Surprises Act's IDR are complex, yet, paradoxically, will likely make the process more efficient. My latest blog walks payers and providers through how the IDR would work according to the proposed rule. Complete w/ helpful timeline illustrating proposed IDR deadlines! Check it out here: https://lnkd.in/e7B8RB7h
NSA Updates: Understanding IDR Process
https://www.zelis.com
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Attention #MedicareAdvantageOrganizations: New requirements released by CMS discuss supplemental benefit encounter data submissions via EDS. Don't get caught off guard by the complexities. Learn how to navigate the process smoothly with our expert guidance. https://bit.ly/4a9ebtZ #MedicareAdvantage #supplementalbenefits #CMS #EDS
Encounter Data System (EDS) Submissions for MA Supplemental Benefits
insights.conveyhealthsolutions.com
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CMS has updated the 2025 FMV compensation amounts to Agents for Medicare Advantage and Prescription Drug sales, removing the $100 increase. See the updated amounts below. #medicare #commission #empowerbrokerage #fyi
Chief Strategy & Growth Officer, DUOS | Podcast Co-Host | Medicare Advantage & Value-Based Care Enthusiast | Business Development | Pragmatic Optimist 🐊🛶
📣 Breaking News: New HPMS Memo Issued by CMS This Afternoon! 🚨 That was fast! Centers for Medicare & Medicaid Services has just issued a new HPMS memo this afternoon, and it's packed with critical updates for both #agents and #MedicareAdvantage plans. 📌 For Agents: Federal regulations stipulate that the compensation amount an organization pays to an independent agent or broker for an initial enrollment must be at or below the fair market value (FMV). Additionally, they also limit renewal compensation to a maximum of 50% of the FMV, and limit the amount an organization may pay for referrals. CMS has updated the CY 2025 FMV amounts previously published in its June 28, 2024, memorandum in light of the court’s preliminary injunction. The updated CY 2025 FMV amounts reflect the annual adjustment to these values but no longer include the administrative payment adjustment based on the provisions of the CY2025 Final Rule subject to the court’s preliminary injunction. The updated CY 2025 FMV amounts are in the image below! (SPOILER: They have been reduced). 🗓 For Plans: Federal regulations require organizations to report to CMS whether they intend to use employed, captive, or independent agents or brokers in the upcoming plan year and the specific rates or range of rates they will pay independent agents and brokers. Plans must provide this data to CMS by the last Friday in July, which is July 26, 2024, for the 2025 plan year. Due to changes made by the CY2025 Final Rule, this function was removed from HPMS. However, CMS will reinstate the ability to submit this data by July 19, 2024. Given the uncertainty presented by pending litigation, the previous inability to submit this data, and shifting regulatory requirements, CMS will not pursue compliance actions against plans for failing to submit data by July 26, as long as plans make a good faith effort to submit the requisite data in HPMS in a timely manner. More thoughts and updates to come and I will be posting later today! I would love to hear your thoughts as to what this means!!!
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Minimizing liens and protecting future Medicare/ Medicaid benefits | Medicare Set Aside Problem Solver | Computer Software Exec | The Best is Yet to Come
Medicare sent an email earlier today with a reminder about upcoming system modernization activities. "This is a reminder that due to system modernization activities, there will be outages to the following Coordination of Benefits & Recovery (COB&R) applications and operations: - Medicare Secondary Payer Recovery Portal (MSPRP) - Commercial Repayment Center Portal (CRCP) - Benefits Coordination & Recovery Center (BCRC) and Commercial Repayment Center (CRC) Call Centers The outages are currently scheduled for the following days and times: Date: Friday, June 28, 2024, through Monday July 1, 2024 Time: 2:00 PM ET Friday through 7:00 AM ET Monday Additional Information: Call Center Will Not Be Available; Operations Will Resume on Monday, July 1 at 8:00 AM ET. We apologize for the inconvenience." Seems like all those Medicare announcements from the 1st half of 2024 are being built into the system this weekend.
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Navigating the complexities of Medicare A's Patient-Driven Payment Model (PDPM) can be a bit like a treasure hunt, especially when it comes to the intricacies of the Minimum Data Set (MDS) 3.0. Here's a golden nugget that might just make your day: One of the most commonly overlooked elements is the Assessment Reference Date management. Did you know that setting the ARD on Day 8 instead of Day 2 could potentially impact your facility's Medicare revenue by hundreds of dollars PER DAY PER CLAIM? That's right, the timing of the ARD is crucial as it captures the services and diagnoses that determine your reimbursement rates. So, let's make sure we're not leaving money on the table! A thorough chart review on Day 8, including preadmission records, can help ensure that all relevant care and services are accounted for. Remember, it's not just about getting the paperwork done; it's about maximizing the care for our patients and the fiscal health of our facilities. Keep this tip in mind; you might find your PDPM process as rewarding as finding a hidden gem! For more insights on avoiding common PDPM missteps, DM me. I'll connect you with our MDS expert, Garrett Laughlin. Happy treasure hunting! 🏆💡 #healthcareMDS #limitlessli #offsitestaffing #snfs #PDPM
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My clients have been worried about the Coding Intensity Factor (CIF) in ACO REACH ever since it was first announced years ago. The CIF was quite tame in 2021 and 2022, but 2023's CIF is going to hurt. This paper I wrote with Caroline Li explains what the CIF is and offers some thoughts about how it will affect REACH ACOs' financials. https://lnkd.in/g93yanH2
Interactions between the CIF and the +/- 3% risk score floor and ceiling in ACO REACH
milliman.com
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Want to understand how the #MedicareAdvantage Payment Schedule works? Learn how the current year’s diagnoses predict the following year’s payments. https://lnkd.in/gp67wQQV #MedicareAdvantage #AIinHealthcare #EMCodes #HCCCodingSoftware #RAFScore #PHIvsPII #PredictiveAnalyticsinHealthcare #MachineLearninginHealthcare #NaturalLanguageProcessinginHealthcare #ComputerAssistedCoding #MedicalAlgorithms
Making Sense of the Medicare Advantage Payment Schedule
foreseemed.com
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Keep your organization up to date by learning how the 2024 Physician Fee Schedule Final Rule impacts the Medicare Shared Savings Program in this Moss Adams article by me and Pat Oungpasuk. The article examines the most notable impacts to the MSSP including moving ACOs toward a digital measurement of quality, refinements to ACOs’ financial benchmarking methodology, adding a third step to the beneficiary assignment methodology and modifications to Advance Investment Payment (AIP) policies.
2024 Physician Fee Schedule Final Rule Impacts Medicare Shared Savings Program
mossadams.com
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Attention #MedicareAdvantageOrganizations: New requirements released by CMS discuss supplemental benefit encounter data submissions via EDS. Don't get caught off guard by the complexities. Learn how to navigate the process smoothly with our expert guidance. https://bit.ly/3wP9yHp #MedicareAdvantage #supplementalbenefits #CMS #EDS
Encounter Data System (EDS) Submissions for MA Supplemental Benefits - Pareto Intelligence
https://paretointel.com
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67% of hospitals had negative Medicare margin in 2022, shining a spotlight on accurate documentation and code assignment. Now is the time to assess where you are at in your CDI and Coding programs. https://lnkd.in/g6qJ66tS
Infographic: Medicare Significantly Underpays Hospitals for Cost of Patient Care | AHA
aha.org
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