HealthAxis Blog

Building the Healthcare System of the Future

Medicare Advantage gets supplemental benefits flexibility, including for transport

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MA plans must still offer all enrollees uniform benefits, premiums and cost sharing. “Under the bipartisan budget deal signed by the president in February, Congress expanded supplemental benefits for the chronically ill to include those that “have a reasonable expectation of improving or maintaining the health or overall function of the chronically ill enrollee and may not be limited to being primarily health related benefits.” The law also authorizes CMS to waive uniformity requirements, but only with respect to supplemental benefits for enrollees with chronic conditions. As healthcare’s focus shifts […]
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CMS offering $30 million in grant funding to improve quality measures

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The funding is to develop partnerships with health systems, clinicians and others to improve measures in the quality payment program of MACRA. “The Centers for Medicare and Medicaid Services is providing up to $30 million in grant funding to develop partnerships with health systems, clinicians and others to improve measures in the quality payment program of MACRA. CMS will provide funding and technical assistance in these cooperative agreements to address measure gaps. Focusing on patient perspectives will ensure measures focus on what is important to patients and drive the improvement […]
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Three reasons telemedicine will grow in 2017

Biggest Health IT wins for new spending bill

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HIMSS Senior Director of Congressional Affairs broke down how the massive spending bill will boost telehealth, Medicaid and other crucial health IT needs. “Congressional leaders passed the spending bill last night, after a 5-hour government shutdown. Senate passed the spending bill around 1:45 a.m. with a 71-28 vote, while the House pushed through the legislation at about 5:30 this morning with a 240-186 vote. One of the biggest gains from the budget was the inclusion of the CHRONIC Care Act, which unanimously passed the Senate in September. HIMSS provided technical […]
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Payers, Providers Pledge to Improve Prior Authorizations

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AHIP, BCBSA, AHA, and other organizations have agreed to improve the efficiency of prior authorizations. “Leaders of organizations participating in the pledge claim that aligning goals to improve prior authorizations can reduce the challenges of payers, providers, and other healthcare organizations face when managing high-cost prescriptions and medical devices. “Prior authorization approvals can be burdensome for health care professionals, hospitals, health insurance providers, and patients because the processes vary and can be repetitive, AHIP said in a press release. Prior authorization requirements can be better targeted if they take into […]
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CMS MBI Notification

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Client Notification Date:  February 15, 2018 Topic: MBI Purpose: The following notification is to inform our Medicare Health Plan clients that HealthAxis Group is following CMS protocols and will be fully compliant with the project to receive & store the new MBI number that will be assigned to Medicare members. CMS Social Security Number Removal Initiative (SSNRI) The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 mandates the removal of the Social Security Number (SSN)-based HICN from Medicare cards to address current risk of beneficiary medical identity theft. Therefore, the […]
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How Payers, Providers Could Streamline Medical Claims Management

All-Payer Claims Databases Offer Insights into Healthcare Spending

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The data from an all-payer claims database can reduce wasteful healthcare spending by supporting population health and analytics-driven healthcare decision making. “All-payer claims databases (APCDs) allow payers, providers, and regulators to analyze claims from millions of beneficiaries to learn where spending is directed and whether or not spending on certain healthcare services is avoidable. State-level all-payer claims databases can help stakeholders to manage population health and identify opportunities to reduce wasteful or preventable healthcare spending within the commercial and public insurance sectors. Sixteen states currently have APCDs in operation, while […]
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CMS launches voluntary bundled payments model, first since spiking mandatory bundles

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The agency’s Innovation Center said the new Bundled Payments for Care Improvement Advanced model is the first APM that would qualify under MACRA. “The Centers for Medicare and Medicaid Innovation Center has launched a new voluntary bundled payment model called Bundled Payments for Care Improvement Advanced — which CMS Administrator Seema Verma said is the first Advanced APM. The current Bundled Payments for Care Improvement Initiative, or BPCI, is scheduled to end on Sept. 30. BPCI Advanced starts on Oct. 1 and runs through Dec. 31, 2023. The BPCI will qualify […]
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Medical Device Data, UDIs on Claims Impact Costs, Patient Safety

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According to recent reports, payers who incorporate medical device data and UDIs into their claims may improve costs and patient safety. “Adding medical device data and unique device identifiers (UDIs) to insurance claims could have a significant positive impact on healthcare spending and patient safety, according to reports from Pew Charitable Trusts, Brigham and Womens Center of Surgery and Public Health, and OIG. However, most insurance providers, including Medicare, do not have the data collection methodologies in place to gather this valuable information, leaving providers, patients, and payers at risk […]
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HealthAxis care management portal

Claims Analytics Help Medicare Identify, Prevent Provider Fraud

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The use of a claims analytics platform helped Medicare to identify and prevent millions of dollars in provider fraud. “Close to a quarter of new Medicare fraud investigations started with the use of a claims analytics platform that has helped to save approximately $6.7 million in incorrect billings, a new GAO report found. After reviewing fraud prevention procedures and technologies within Medicare in 2016, GAO determined that the Fraud Prevention System (FPS) helped Medicare take corrective actions against 90 providers by suspending improper payments. The review also suggested that the FPS […]
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Does Blockchain Have A Place In Healthcare?

Quality Payment Program needs more technical assistance, oversight, OIG finds

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A new report by HHS’ Office of Inspector General gives CMS points for making significant efforts to implement the Quality Payment Program (QPP) but says challenges remain that could undermine the program’s success. “Without sufficient technical assistance, participating clinicians could struggle to succeed, while others may opt out of the program altogether, the report warns. CMS also needs to develop a comprehensive program integrity plan to guard against fraud and improper payments, according to OIG. In terms of implementing QPP, CMS has focused heavily on clinician readiness and acceptance of the […]
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