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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How Payers Could Assist Primary Care Docs with Value-Based Care

AHIP asks CMS to change Medicare Advantage payment formula

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The Centers for Medicare and Medicaid Services should update its county benchmark calculation in the 2019 final notice being published April 2. “America’s Health Insurance Plans is asking the Centers of Medicare and Medicaid Services to change the way the agency calculates Medicare Advantage payment rates, ahead of a final notice due out Monday. AHIP said it strongly believes CMS should update its benchmark calculation in the 2019 final notice. These reflect spending for enrollees with only Medicare Part A for care in hospitals and other facilities, enrollees with only […]
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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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A Healthy Start to the Plan Year Begins With Quality Medicare Advantage Enrollment Processes

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For individuals who have Medicare, they have recently had the opportunity to enroll in a 2018 Medicare Advantage or other Medicare plan, review their current coverage, or change plans.  Health plans across the country are evaluating their successes and opportunities for improvement from the recently closed Open Enrollment Period. Every year, health plans wrestle with timely, accurate enrollment and compliant submission to CMS.  Setbacks and headaches here are felt keenly, as it is the first opportunity for plans to succeed or fail relative to the Medicare Star rating system for […]
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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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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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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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All but 2 states pay for live video Medicaid encounters

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Healthcare Dive Brief “Medicaid programs in 48 states and the District of Columbia reimburse for some form of live video encounters, the Center for Connected Health Policy reported. The two states that don’t have written reimbursement policies for telehealth are Massachusetts and Rhode Island. While far more states reimburse for live video than store-and-forward and remote patient monitoring, the latter are starting to gain some traction. The new report, which updates CCHP’s annual State Telehealth Laws and Reimbursement Policies guide, focuses mainly on Medicaid fee-for-service policies.”  Read the full article. Check […]
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Building the Healthcare System of the Future

CMS takes aim at regulatory reforms to ease provider burden

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Lack of productivity and increased workload among top complaints from providers surveyed The Centers for Medicare and Medicaid Services is committed to reducing the regulatory burden on providers with several new initiatives as part of the Trump administration’s broader efforts to cut red tape in the federal government, according to CMS Administrator Seema Verma. According to Verma, CMS is one of the top agencies in terms of the volume of regulations it generates—11,000 pages every year, and she contends that “too much regulation can have a suffocating effect on the […]
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