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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What do upcoming changes to CMS’s split/shared billing policy mean for valuation and benchmarking? Maria Hayduk and Kathryn A. Taylor, CPA/ABV, ASA, MBA Taylor explain in part 5 of our blog series. I'd recommend taking a look at the entire series, which can be found here: https://lnkd.in/dp-yDrki #splitshared #FMV #ecgmc
Split/Shared Billing: Fair Market Value and Benchmarks
ecgmc.com
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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 Medicare maze? Here's your quick guide to ensuring your claims are 💯 spot-on and payment-ready! 1️⃣ Accuracy is Key: Double-check patient info like name, DOB, and Medicare ID. A tiny error can derail the entire process! 2️⃣ Full Docs or Nothing: Skimping on documentation is a no-go. Complete records are a must for seamless claim approval. 3️⃣ Coding with Precision: Get those ICD-10 and CPT/HCPCS codes right. Aim for specificity to avoid claim delays. 4️⃣ Modifiers Matter: They're not just add-ons but crucial for detailing the nuances of the services provided. Use wisely! 5️⃣ Watch the Clock: Stick to Medicare’s filing deadlines to dodge penalties. Remember, you've got a year from the service date. 6️⃣ Provider Enrollment Check: Only enrolled and credentialed providers can bill. Navigate the incident-to and split/shared billing with care. 7️⃣ Guidelines Galore: Stay updated with LCDs, LCAs, and NCDs for what’s covered and what’s not. 8️⃣ Go Digital: Embrace EDI for faster, more accurate claim submissions. Say goodbye to paperwork errors! 9️⃣ Integrity First: Keep your billing honest—no upcoding or unbundling. Medicare’s watching! 🔟 Be Responsive: Quick replies to Medicare’s requests can mean faster claim processing. 💡 Stick to the guidelines and watch your Medicare claims process smoothly and accurately. Here’s to getting it right and getting paid! 💰📈 #HealthcareBilling #MedicareClaims #MedicalCoding #HealthcareTips
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The results for the previous Direct Contracting Entities (DCE) model, which is now the ACO REACH model, show that a large majority of the programs were successful not only in providing savings to CMS that are shared with the program, but also with quality measures averaging at or above 99%. If you are considering joining for 2025, contracting with a successful partner and using analytics tools like Acclivity can improve your chances for success. Read this article about how success was measured. https://okt.to/XfkznU
Three quarters of ACOs in direct contracting model earned savings
healthcarefinancenews.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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What do upcoming changes to CMS’s split/shared billing policy mean for valuation and benchmarking? Maria Hayduk and Kathryn Taylor explain in part 5 of our blog series. #splitshared #FMV #ecgmc
Split/Shared Billing: Fair Market Value and Benchmarks
ecgmc.com
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What do upcoming changes to CMS’s split/shared billing policy mean for valuation and benchmarking? Maria Hayduk and Kathryn Taylor explain in part 5 of our blog series. #splitshared #FMV #ecgmc
Split/Shared Billing: Fair Market Value and Benchmarks
ecgmc.com
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