Medicare Advantage patients account for fewer avoidable hospitalizations. Here's why
Fierce Healthcare
FEBRUARY 27, 2023
Medicare Advantage patients account for fewer avoidable hospitalizations. Here's why rking Mon, 02/27/2023 - 17:41
CMS holds accountable care organizations harmless for ‘highly suspect’ Medicare billing
Health Care Dive
SEPTEMBER 25, 2024
Aberrant billing for urinary catheters last year could have made it harder for ACOs in Medicare to bring in shared savings. That’s no longer the case under a new final rule.
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Optum study: Accountable Medicare Advantage models produce better outcomes, greater efficiency
Fierce Healthcare
FEBRUARY 17, 2023
Optum study: Accountable Medicare Advantage models produce better outcomes, greater efficiency pminemyer Fri, 02/17/2023 - 13:40
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Medicare saves record $2.1 billion from largest accountable care program
Health Care Dive
OCTOBER 31, 2024
Citrus ACO in Central West Florida had the highest savings rate, while Health Connect Partners — an ACO operated by hospital giant Providence — had the highest total savings in the Medicare Shared Savings Program last year.
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MSSP ACOs saves Medicare $2.1 billion in 2023, the largest savings in program history
Fierce Healthcare
OCTOBER 29, 2024
Accountable care organizations saved Medicare $2.1 billion, the largest yearly savings in program history, in 2023, the Centers for Medicare & Medicaid Services revealed on Tuesday. Accountable care organizations (ACOs) saved Medicare $2.1
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These 10 drugs account for 22% of Medicare Part D spending: KFF
Fierce Healthcare
JULY 13, 2023
Approximately 22% of gross Medicare Part D spending can be attributed to 10 top-selling prescription drugs, according to analysis from KFF. | A new analysis shows a small number of prescription drugs disproportionately make up Medicare Part D spending.
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Government watchdog warns of Medicare fraud after relaxing provider requirements
Health Care Dive
DECEMBER 20, 2022
The Government Accountability Office is urging the CMS to resume certain eligibility checks on providers whom they consider at high risk of fraud to the Medicare program.
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Even modest meds adherence can be financially transformative for health systems
Healthcare It News
JANUARY 23, 2025
As healthcare continues to advance with accountable care organizations and value-based care models, the industry is starting to see some real traction after a decade of groundwork in the form of CMS claims for the Medicare Shared Savings Program. There are some critical elements driving success here.
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Compassus CEO: To ‘Grow Up,’ Home Health Industry Needs To Become Accountable
Home Health Care
NOVEMBER 27, 2024
One comment you made at HHCN’s FUTURE event, which I thought was interesting, was that there needs to be a maturation process in the home health industry in order to capitalize off of some of the opportunities that are out there, specifically in Medicare Advantage (MA). In a lot of cases, the home-based care isn’t accountable.
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CMMI wants every Medicare beneficiary in an accountable care plan by 2030
Health Care Dive
OCTOBER 21, 2021
Officials acknowledged provider concerns that current models are too burdensome and benchmarks too complex, which the innovation center aims to rectify.
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Senate Finance Committee tackles Medicare physician pay reform
Health Care Dive
MAY 20, 2024
On Friday, the committee released a white paper proposing Medicare adjust doctor reimbursement to account for inflation, a key goal for physician lobbies.
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ACOs led by independent physicians save Medicare ‘substantially’ more money, CBO says
Health Care Dive
APRIL 17, 2024
Independent practices have clearer financial incentives to lower medical spending than hospitals participating in accountable care organizations, according to the Congressional Budget Office.
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HHS OIG: 2 in 5 Medicare beneficiaries used telehealth during first pandemic year
Healthcare It News
MARCH 30, 2022
Department of Health and Human Services Office of Inspector General released a study examining how Medicare beneficiaries used telehealth during the first year of the COVID-19 pandemic. "Telehealth was critical for providing services to Medicare beneficiaries during the first year of the pandemic," read the report.
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An Overview of Medical Billing and Coding Services
p3care
NOVEMBER 1, 2024
Various government organizations like the Centers for Medicare and Medicaid Services (CMS) and CDC’s National Center for Health Statistics (NCHS) govern these processes to ensure smooth operations. Improved Revenue It will reduce your days in accounts receivable management (AR) by reducing the claim denials ratio and boosting revenue.
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Flexible Medicare MIPS Reporting Options Available Amidst Corona
p3care
NOVEMBER 25, 2020
In the last quarter of 2020, CMS (Centers for Medicare & Medicaid Services) announced the performance scores for clinicians of QPP MIPS 2019 on its official site. It accounts for quality healthcare services, that CMS recognizes and rewards for. Check Points for Performance Review.
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CMS officials say agency is monitoring concerns from ACOs about DME costs
Fierce Healthcare
APRIL 11, 2024
Accountable care organizations have sounded the alarm on billions in durable medical equipment fraud, and officials at the Centers for Medicare & Medicaid Services (CMS) said Thursday that the | Accountable care organizations have sounded the alarm on billions in durable medical equipment fraud, and officials at the Centers for Medicare & Medicaid (..)
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CVS, Rush partner on new ACO for Chicago Medicare patients
Health Care Dive
JANUARY 24, 2023
Rush University will be the only Chicago-area academic medical center participating in CVS’ first accountable care organization in ACO REACH.
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CMS proposed payment rule includes major updates for ACOs
Health Care Dive
JULY 8, 2022
Changes to the Medicare Shared Savings Program would give some accountable care organizations more time to ramp up to performance-based risk and updated quality reporting.
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Care coordination: What's needed to succeed with accountable care and home health?
Healthcare It News
MARCH 4, 2022
Medicare spends nearly $60 billion on post-acute care annually. Why do you suggest that care coordination with post-acute providers will become more critical than before to support the rise of value-based care? What needs to happen? Post-acute care is a key part of the care continuum and a significant component of healthcare spend.
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Shared Savings ACOs saved Medicare $1.8B in 2022
Health Care Dive
AUGUST 25, 2023
Nearly two-thirds of participating accountable care organizations earned payments for their performance last year, according to the CMS.
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Variability in Medicare direct contracting savings illustrates promises, pitfalls of value-based care
Health Care Dive
DECEMBER 9, 2022
Accountable care organizations' net savings rates ranged from -29.4% in the 2021 Global and Professional Direct Contracting Model.
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Payers' increasing claims denials, delays 'wreaking havoc' on provider revenue cycles
Fierce Healthcare
DECEMBER 13, 2023
A jump in claim delays and denials is “wreaking havoc on providers’ revenue cycle performance” and contributing to health systems’ “volatile” accounts receivable and diminishing cash reserves, acco | More frequent pushback from commercial and Medicare Advantage payers is complicating patient self-pay collections and, ultimately, undermining the revenues (..)
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ACO Reach program savings grew larger in 2023. NAACOS is angling for the model's extension
Fierce Healthcare
NOVEMBER 11, 2024
Accountable care organizations in the ACO Reach program can claim credit for saving the Centers for Medicare & Medicaid Services (CMS) hundreds of millions of dollars | CMS released favorable savings results for ACO REACH Model participants, as industry group NAACOS begins to push for the program's extension through 2030.
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ACO sign-ups for 2024 are underway. Policy changes have helped, but more work is needed, experts say
Fierce Healthcare
JUNE 8, 2023
Phase 1 enrollment in the Medicare Shared Savings Program (MSSP) for 2024 is currently underway, and recent reforms hold promise in attracting new providers into accountable care.
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ACOs to receive $20M in advance investment payments
Fierce Healthcare
JANUARY 29, 2024
In 2024, 50 accountable care organizations are new to the Medicare Shared Savings Program and 71 ACOs renewed participation, according to new numbers released by Centers for Medicare & Medicaid | CMS released new data Monday showing ACO participation in the Medicare Shared Savings Program, with 19 ACOs set to participate in a new payment option, (..)
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ACOs not shown to improve mental health outcomes: study
Fierce Healthcare
NOVEMBER 29, 2023
Accountable care organizations do not positively influence treatment and outcomes for chronic mental health conditions for Medicare patients, according to a study in Health Affairs. | A new study pours water on the belief that ACOs are well-suited to handle chronic mental health conditions its patients experience.
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Clover Health exits ACO REACH
Health Care Dive
DECEMBER 6, 2023
The beleaguered insurer will leave the accountable care program at the end of the 2023 performance year following disappointing results in Medicare direct contracting.
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2025: AI enhances personalized care; caregiver experience in the spotlight
Healthcare It News
FEBRUARY 20, 2025
It also calls for a mindset shift – as patients are no longer bystanders in their care, it's vital to be transparent with patients and consistently iterate on services and treatments that take consumer feedback into account."
CMS tweaks ACO REACH to stabilize model
Health Care Dive
AUGUST 15, 2023
Regulators lowered enrollment minimums for accountable care organizations in the program, which allows providers to form groups to manage care and costs for fee-for-service Medicare enrollees.
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CMS Proposes Over 4% Cut To Home Health Medicare Payments In 2025
Home Health Care
JUNE 26, 2024
Centers for Medicare & Medicaid Services (CMS) published its FY 2025 home health proposed payment rule Wednesday. Overall, CMS estimates that Medicare payments to home health agencies in CY 2025 would decrease in the aggregate by 1.7%, or by about $280 million, compared to 2024 levels. This is a developing story.
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Fixing A ‘Badly Broken Medical System’: Home Care Leaders Testify Before Congress On Post-Acute Care
Home Health Care
MARCH 11, 2025
Our Medicare program has evolved over the past decade, and we are here to ensure that patients have sufficient access to care. Madison spoke about her 31 years of experience running a home health agency, where traditional Medicare covered most patients. These are not just policy decisions, Fleece stated.
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HIMSSCast: Whole person care and data interoperability drivers
Healthcare It News
OCTOBER 13, 2023
Social determinants of health – the food, shelter and security attributes of patients that exist outside of care settings – contribute disproportionate risks for disease, hospital readmissions and a lack of access to quality healthcare among vulnerable populations, including people on Medicare.
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Risk Adjustment and Incentives for Upcoding in Medicare
Healthcare ECONOMIST
MAY 5, 2024
To account for differences in disease burden across a Medicare Advantage (MA) plans patient population, uses risk adjustment based on patient disease burden. One key question is whether providers under traditional Medicare (TM) code differently than Medicare Advantage (MA) plans. diabetes, heart failure).
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Moving aging patients from confusion to the point of care
Healthcare It News
SEPTEMBER 16, 2024
By making use of technologies such as artificial intelligence, providers can empower senior patients with the extra guidance and support that informs them and gets them to the point of care, according to Karl Ulfers, cofounder and CEO at DUOS, a senior-focused digital care navigation platform designed for Medicare beneficiaries.
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NAACOS worries new ACO REACH changes could force exits
Fierce Healthcare
AUGUST 2, 2024
The Centers for Medicare & Medicaid Services (CMS) quietly released changes to the ACO REACH Model, prompting one industry group to react to the modifications. Accountable care organizations are evaluating the impacts of the new requirements for the ACO REACH program. So far, the changes are a mixed bag, says NAACOS.
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MedPAC Recommends ‘Misguided and Deeply Troubling’ Home Health Payment Cut
Home Health Care
DECEMBER 16, 2024
For the second consecutive year, the Medicare Payment Advisory Commission (MedPAC) has issued a draft recommendation advising Congress to reduce Medicare payments to home health agencies by 7% beginning in 2026. Future payment reductions and clawbacks are certain under the agencys interpretations of its current statutory obligations.
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Diabetes WA reports hack and more briefs
Healthcare It News
APRIL 5, 2024
Based on its initial investigation, the following information may have been accessed by hackers: name, address, birth date, email, telephone number, marital status, Aboriginal status, Medicare number, referring doctor, and type of diabetes.
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CMS Proposed Changes for ACO Reporting 2021
p3care
FEBRUARY 10, 2021
From the next performance year (2021), Accountable Care Organizations (ACOs) expect different reporting requirements under the Medicare Shared Savings Program. CMS (Centers for Medicare and Medicaid Services) has recommended changes for ACO reporting criteria. The requirements are somewhat the same as for QPP MIPS.
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On which drugs does Medicare spend the most?
Healthcare ECONOMIST
JULY 21, 2023
The Kaiser Family Foundation (KFF) identifies the Part D drugs on which Medicare spends the most money. In 2021, Medicare Part D covered more than 3,500 prescription drug products, with total gross spending of $216 billion, not accounting for rebates paid by drug manufacturers to pharmacy benefit managers (PBMs).
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Health Insurance in Aisle 3: Why a Grocery Chain is Working on Medicare
Health Populi
AUGUST 3, 2021
“You can trust us to help you find the right Medicare coverage for you and your lifestyle,” the tagline reads. It is, specifically, Midwest Heritage, Hy-Vee’s banking, insurance and investments subsidiary, that will implement the Medicare Aisle program.
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Medicare Advantage Penetration Plateau Provides Home Health Tailwind
Home Health Care
MAY 16, 2024
This article is a part of your HHCN+ Membership If there were ever a time for Medicare Advantage-related troubles to cool off in the home health care space, now would be it. For the first time ever, in 2023, there were more Medicare beneficiaries under an MA plan than traditional Medicare.
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CVS creating new ACO in South Carolina through REACH program
Fierce Healthcare
APRIL 16, 2024
CVS Accountable Care and inVio Health Network, a collection of more than 600 providers in South Carolina, are partnering to improve care outcomes for 60,000 Medicare beneficiaries. |
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Enhabit Defends Medicare Advantage Strategy, Overhead Costs
Home Health Care
JUNE 24, 2024
NYSE: EHAB) defended its strategy of taking on more Medicare Advantage (MA) revenue over the last couple of years. Enhabit now has about 61% of its home health revenue tied to fee-for-service Medicare. At that time, traditional Medicare made up approximately 75% of Enhabit’s total Home Health revenue. “At of Enhabit shares.
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How Home Health Agencies Can Adapt To TEAM and HHVBP Models
Home Health Care
JANUARY 22, 2025
The landscape of home health care is evolving through the introduction of two key models designed to improve patient outcomes and reduce costs: the expanded Home Health Value-Based Purchasing (HHVBP) model and the Targeted Episode-Based Medicare Access and Payment (TEAM) model. It was implemented on Jan. territories.
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