HIT Consultant

JANUARY 19, 2025

Technology is changing the game by offering innovative means to address the challenges of content management, quality assurance, regulatory compliance, translation and beyond.

Medicare 52

Medicare Quality Assurance Medicaid Integration 52

Healthcare It News

NOVEMBER 30, 2021

The New York State Health Home program is designed for the neediest Medicaid patients and aims to reduce overall healthcare costs by decreasing inpatient costs (and utilization) by addressing social determinants of health such as housing, transportation and food. THE PROBLEM.

Quality Assurance 290

Quality Assurance Prevention Hospitals Telemedicine 290

NCQA

DECEMBER 18, 2024

For Measurement Year 2024, we will publicly report nine HEDIS measures stratified by race and ethnicity, and provide state, regional and national benchmarks for plans to compare their performance and identify areas that might benefit from targeted quality improvement efforts. Washington, DC: The National Academies Press.

Quality Assurance 52

Quality Assurance Accountability Quality Improvement Pharmaceuticals 52

NCQA

AUGUST 20, 2024

Census regions to determine plans’ geographic location, and looked at results for commercial, Medicare and Medicaid products. HEDIS ® is a registered trademark of the National Committee for Quality Assurance. One reason may be the recent (MY 2019) addition of the Medicare product line to the HEDIS antibiotics measures.

Quality Assurance 98

Quality Assurance Medicare Medicaid Prevention 98

NASHP

APRIL 17, 2023

Performance measurement is a pillar of state Medicaid managed care quality improvement and oversight efforts, is often factored into plan payment, and supports public reporting. 42 Medicaid agencies collected at least one measure of behavioral health performance. Check out the map and chart below for an overview of our findings.

Medicaid 52

Medicaid Quality Assurance Quality Review Accountability 52

NASHP

MAY 9, 2022

Person-driven outcomes ” are personalized, structured, measurable goals identified by a person with complex health status or caregiver and can be used for both care planning and quality measurement. National Committee for Quality Assurance (NCQA), in partnership with the SCAN Foundation and The John A. Measures that Matter.

Medicaid 98

Medicaid Quality Assurance Primary Care Nursing 98

NASHP

APRIL 17, 2023

In addition, starting in 2024, federal rules will require states to report performance on some measures, including some behavioral health measures, to the Centers for Medicare & Medicaid Services (CMS). 1] All but one of these Medicaid agencies collected at least one measure of behavioral health performance.

Medicaid 52

Medicaid Quality Assurance Quality Improvement Quality Review 52

NASHP

JANUARY 3, 2022

As states continue developing their health equity strategies, an emerging consideration is how commercial algorithms that are used by states’ Medicaid managed care organizations to inform clinical care decisions may exhibit significant bias. . Pennsylvania has taken steps to better understand how to mitigate the racial bias of algorithms.

Quality Assurance 75

Quality Assurance Medicaid Prevention Healthcare 75

NASHP

AUGUST 23, 2021

Primary care case management (PCCM) programs are one of the oldest types of Medicaid managed care, but over time most states have shifted to use managed care organizations (MCOs) to deliver services to Medicaid participants. million Medicaid participants. million Medicaid enrollees.

Primary Care 64

Primary Care Medicaid Accountability Quality Improvement 64

Home Health Care

NOVEMBER 2, 2023

Pansy is still involved in the company’s training program, and on the quality assurance side. Pansy Homecare is a mostly private-pay agency, but the company also has a contract with the VA, as well as a contract with the Medicaid waivers program. Pansy’s son, Jonah, has since taken helm of the company.

Home Care 109

Home Care Quality Assurance Medicaid 109

NASHP

DECEMBER 10, 2021

The information on this map comes from a 50-state survey of a variety of stakeholders, ranging from Medicaid officials to Community Health Workers, on their states’ approaches?to?integrating?CHWs MHP Medicaid Health Plans. NCQA National Committee for Quality Assurance. Medicaid Reimbursement. integrating?CHWs

Medicaid 122

Medicaid Primary Care Prevention Nursing 122

HIT Consultant

MAY 23, 2024

Focus on Medicaid Populations Boulder Care specifically targets underserved communities, including those covered by Medicaid. Serving primarily Medicaid members under value-based arrangements, Boulder Care has partnered with numerous health plans to link reimbursement directly to successful outcomes.

Quality Assurance 52

Quality Assurance Medicaid Hospitals Healthcare 52

HIT Consultant

APRIL 26, 2023

What You Should Know: – The National Committee for Quality Assurance (NCQA) today launched the Race and Ethnicity Stratification Learning Network, a free, interactive, online tool that offers data and best practices to help health plans improve how they collect race and ethnicity data on their enrollees.

Quality Assurance 52

Quality Assurance Quality Improvement Medicaid Medicare 52

HIT Consultant

SEPTEMBER 7, 2022

Code is written by humans who have unconscious biases, and those biases can creep into the algorithms of AI when Quality Assurance functions are not properly sensitized to detect them. Bias remains a big concern in AI development and use.

Population Health 98

Population Health Health Analytics Quality Assurance Medicaid 98

NCQA

SEPTEMBER 17, 2024

This year, 1,019 commercial, Medicare and Medicaid health plans earned a rating from NCQA. There was a slight increase in Medicare and Medicaid plans that achieved 4- and 4.5-star star ratings, demonstrating improvement across several health quality measures. Learn more about that change here.

Quality Assurance 52

Quality Assurance Medicaid Medicare Patient Experience 52

NASHP

NOVEMBER 15, 2021

As states continue developing their health equity strategies, an emerging consideration is how commercial algorithms that are used by states’ Medicaid managed care organizations to inform clinical care decisions may exhibit significant racial bias.

Quality Assurance 52

Quality Assurance Medicaid Population Health Prevention 52

Sequence Health

FEBRUARY 15, 2023

This is due to increased training and management for quality assurance. Monitoring Medicare And Medicaid Patient Expenses Healthcare providers often take on expenses related to diagnosing or treating certain patients that are on Medicare or Medicaid. This can be time-consuming and difficult to assess.

Quality Assurance 52

Quality Assurance Private Practices Medicare Medicaid 52

Home Health Care

APRIL 3, 2022

Overall, I feel there is a tremendous opportunity for HouseWorks as we continue to grow into the Medicaid-based business we have entered in via the Connected and Greater Boston acquisitions, while also not losing focus on the core private pay business HouseWorks built its reputation on. Mike Trigilio, CEO of HouseWorks.

Home Care 122

Home Care Quality Assurance Integration Hospitals 122

NCQA

JULY 31, 2024

Many of our HEDIS measures are used in quality reporting and value-based purchasing by Medicare, Medicaid and commercial insurance plans. HEDIS ® is a registered trademark of the National Committee for Quality Assurance (NCQA). Visit www.sozoseifoundation.org to learn more.

Quality Assurance 52

Quality Assurance Regulations Quality of Care Medicaid 52

NASHP

SEPTEMBER 1, 2021

For many years, states have worked to ensure that Medicaid participants have access to patient-centered medical homes (PCMH). In 2010, the Affordable Care Act (ACA) authorized state Medicaid programs to create health homes to improve and better coordinate the full range of services needed by Medicaid beneficiaries with chronic health needs.

Medicaid 64

Medicaid Primary Care Hospitals Quality Assurance 64

Sequence Health

JANUARY 9, 2025

Regulatory bodies like the Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) dictate billing compliance rules, thereby laying down a regulatory structure within which healthcare call centers operate.

Quality Assurance 52

Quality Assurance Healthcare Regulations Healthcare Providers 52

HIT Consultant

JUNE 28, 2024

This staggering figure does not even consider the additional losses incurred by hospitals as a result of underpayments from government-funded healthcare programs such as Medicare and Medicaid.

Quality Assurance 52

Quality Assurance Healthcare Providers Patient Experience Medicaid 52

HIT Consultant

JANUARY 9, 2023

In 2020, the National Kidney Foundation and the National Committee for Quality Assurance developed a new measure for kidney health called the Kidney Health Evaluation for Patients with Diabetes, also known as KED. In December, the Centers for Medicare and Medicaid Services issued a proposal to include KED as a Star Rating.

Quality Assurance 52

Quality Assurance Medicare Medicaid Quality of Care 52

Sheppard Health Law

DECEMBER 3, 2021

On November 12, 2021, the Centers for Medicare and Medicaid Services (“CMS”) revised and finalized draft guidance first issued on May 3, 2019, for co-location of hospitals with other hospitals or healthcare providers [1] (the “ Finalized Guidance ”). The Finalized Guidance also makes significant changes to the guidelines for staffing.

Healthcare Providers 52

Healthcare Providers Quality Assurance Healthcare Hospitals 52

Briggs Healthcare

APRIL 14, 2023

To obtain your CAH PEPPER , the Chief Executive Officer, President, Administrator, Compliance Officer, Quality Assurance/Performance Improvement Officer, or other authorized user within your organization (selecting a job title closest to their title) should: Review the instructions and obtain the information required to authenticate access.

Quality Assurance 40

Quality Assurance Hospitals Rehabilitation Performance improvement 40

Briggs Healthcare

JUNE 28, 2022

The HHVBP Newsletter provides home health agencies (HHAs) with the latest information about the expanded HHVBP Model as well as important tools, news, and timely insights from the Centers for Medicare & Medicaid Services (CMS) and the HHVBP Model Technical Assistance (TA) Team.

Quality Improvement 75

Quality Improvement Quality Assurance Medicare Performance improvement 75

NASHP

AUGUST 24, 2023

There are a number of strategies state health officials can use as they build sustainable access to palliative care services in their Medicaid programs. Target Populations That Could Benefit from Palliative Care Services Use data to identify Medicaid enrollees with serious illness. Make the case for improved care and reduced costs.

Medicaid 52

Medicaid Quality Assurance Hospitals Quality of Care 52

NASHP

DECEMBER 15, 2021

NASHP recently updated a 50-state scan that identifies state approaches to supporting the CHW workforce and catalogues CHW Medicaid financing strategies (see text box 1). Evidence indicates that Medicaid spending on CHW services produces both improved health outcomes and a return on investment. Text Box 5: North Carolina.

Medicaid 52

Medicaid Accountable Care Accountability Quality Assurance 52

Health Dialog

SEPTEMBER 17, 2018

The National Committee for Quality Assurance (NQCA) includes certified or evidence-based decision aids as an element of provider support in the most recent population health management accreditation standards.

Quality Assurance 40

Quality Assurance Population Health Patient Experience Medicaid 40

Briggs Healthcare

APRIL 10, 2023

To obtain your SNF PEPPER , the Chief Executive Officer, President, Administrator, Compliance Officer, Quality Assurance/Performance Improvement Officer, or other authorized user within your organization (selecting a job title closest to their title) should: 1.

Nursing 40

Nursing Quality Assurance Medicare Performance improvement 40

NASHP

MAY 8, 2023

Source: Centers for Medicare & Medicaid Services Health Disparities : Preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations. Medicaid and Racial Health Equity.” Source: Cara James et al., Dutton, Melinda J.,

Medicaid 52

Medicaid Regulations Prevention Medicare 52

NCQA

FEBRUARY 13, 2024

NCQA proposes to expand this measure into the Medicaid product line for members 18–64. HEDIS ® is a registered trademark of the National Committee for Quality Assurance (NCQA). ET) on March 13. Visit [link] to submit comments. For details on proposed changes, visit the NCQA website.

Quality Assurance 52

Quality Assurance Hospitals Medicare Prevention 52

NASHP

OCTOBER 16, 2023

Following approval of the first step, applicants must complete a second step that entails background checks ,[18] an application (form DHS 50) ,[19] and fee payment [20] to DHS Division of Quality Assurance. Once approved, a YCSF certification does not expire and is valid until it is suspended or revoked.

Quality Assurance 64

Quality Assurance Prevention Hospitals Medicaid 64

HIT Consultant

JUNE 28, 2022

The National Committee for Quality Assurance (NCQA) has embarked on a major initiative to drive health equity by introducing race and ethnicity stratifications to its quality measures, beginning in the measurement year 2022. Create a social index score.

Quality Assurance 52

Quality Assurance Population Health Medicaid Hospitals 52

Home Health Care

OCTOBER 29, 2024

Currently, states are allowed to regain the costs of care from recently deceased Medicaid beneficiaries from the sale of their homes. Second, if it is taking over Medicaid programs from states, it would take tremendous effort and political will to reconcile 50 different programs. The proposal moves to end “estate recovery.”

Home Care 116

Home Care Medicare Medicaid Quality Assurance 116

NASHP

MARCH 29, 2024

Approaches include allowing family caregivers to receive Medicaid reimbursement , providing culturally competent trainings and peer supports, making respite care more accessible for caregivers, and offering behavioral health supports for caregivers. recruitment, consultation resources, Medicaid reimbursement, etc.).

Medicaid 124

Medicaid Quality of Care Quality Assurance Nursing 124

NASHP

MAY 8, 2023

For example, in the health care arena, states are leveraging National Committee for Quality Assurance (NCQA) HEDIS measures and requiring Medicaid and commercial health plans to report stratified HEDIS measures. National efforts to standardize are useful to inform state approaches.

Medicaid 52

Medicaid Quality Improvement Hospitals Quality Assurance 52