National Government Services’ Post

Explore the transformative landscape of #valuebasedcare (#VBC) in this overview of anticipated developments for 2024, as presented by Holland & Knight LLP. From accelerated payment model transitions to the strategic leveraging of data and technology, join us as we navigate the evolving terrain of #healthcare delivery and outcomes. ▶️ READ ARTICLE: https://lnkd.in/ePwPJx9T

Great analysis on the challenges of (and the growing gap between) providers using FFS based billing and diagnosis capture, and the increasingly standardized electronic health related data that ACO aligned providers use to support comprehensive care delivery - including financial and utilization data related to resource use. Our work is to support providers on this journey from legacy payment systems and structures. Great article here!

This post is for you if the phrase "an eligible hospital subject to this disincentive would not be able to earn the three quarters of the annual market basket increase associated with qualifying as a meaningful EHR user" makes your head spin. 🤯 Last week, CMS released its proposed rule for provider disincentives for info blocking. The proposal outlined three federal reimbursement programs that CMS would use as avenues for applying the disincentives. Why? 𝗜𝗳 𝘆𝗼𝘂 𝘄𝗮𝗻𝘁 𝘁𝗼 𝘂𝗻𝗱𝗲𝗿𝘀𝘁𝗮𝗻𝗱 𝗵𝗼𝘄 𝗖𝗠𝗦 𝘄𝗶𝗹𝗹 𝗽𝗲𝗻𝗮𝗹𝗶𝘇𝗲 𝗽𝗿𝗼𝘃𝗶𝗱𝗲𝗿𝘀 𝘄𝗵𝗼 𝗲𝗻𝗴𝗮𝗴𝗲 𝗶𝗻 𝗶𝗻𝗳𝗼 𝗯𝗹𝗼𝗰𝗸𝗶𝗻𝗴, 𝗶𝘁'𝘀 𝗰𝗿𝗶𝘁𝗶𝗰𝗮𝗹 𝘁𝗼 𝘂𝗻𝗱𝗲𝗿𝘀𝘁𝗮𝗻𝗱 𝗵𝗼𝘄 𝗽𝗿𝗼𝘃𝗶𝗱𝗲𝗿𝘀 𝗴𝗲𝘁 𝗽𝗮𝗶𝗱 𝗶𝗻 𝘁𝗵𝗲 𝗳𝗶𝗿𝘀𝘁 𝗽𝗹𝗮𝗰𝗲. Since there's a lot to cover, we'll give you some quick background on the Medicare Promoting Interoperability Program in today's post. Follow our page and look out for the next posts that will review the Merit-based Incentive Payment System (MIPS) and the Medicare Shared Savings Program (Shared Savings Program). Got questions about the Medicare Promoting Interoperability Program or CMS' proposed disincentives? Let us know in the comments ⤵️ and we'll answer them as soon as we can. And check out the comments for links to official resources. #interoperability #fhir #ehr #healthtech #digitalhealth

The CMS Innovation Center (CMMI) announced the Transforming Episode Accountability Model, a proposed mandatory episode-based bundled payment model, is slated to begin in January 2026. It is among a list of alternative payment models supporting CMS's goal to have all Medicare beneficiaries in an accountable care relationship by 2030. The five-year model structure marks significant changes from previous versions and reflects how the approach to bundled payments is evolving.

The CMS Innovation Center (CMMI) announced the Transforming Episode Accountability Model, a proposed mandatory episode-based bundled payment model, is slated to begin in January 2026. It is among a list of alternative payment models supporting CMS's goal to have all Medicare beneficiaries in an accountable care relationship by 2030. The five-year model structure marks significant changes from previous versions and reflects how the approach to bundled payments is evolving.

The CMS Innovation Center (CMMI) announced the Transforming Episode Accountability Model, a proposed mandatory episode-based bundled payment model, is slated to begin in January 2026. It is among a list of alternative payment models supporting CMS's goal to have all Medicare beneficiaries in an accountable care relationship by 2030. The five-year model structure marks significant changes from previous versions and reflects how the approach to bundled payments is evolving.

The CMS Innovation Center (CMMI) announced the Transforming Episode Accountability Model, a proposed mandatory episode-based bundled payment model, is slated to begin in January 2026. It is among a list of alternative payment models supporting CMS's goal to have all Medicare beneficiaries in an accountable care relationship by 2030. The five-year model structure marks significant changes from previous versions and reflects how the approach to bundled payments is evolving.

The CMS Innovation Center (CMMI) announced the Transforming Episode Accountability Model, a proposed mandatory episode-based bundled payment model, is slated to begin in January 2026. It is among a list of alternative payment models supporting CMS's goal to have all Medicare beneficiaries in an accountable care relationship by 2030. The five-year model structure marks significant changes from previous versions and reflects how the approach to bundled payments is evolving.

The CMS Innovation Center (CMMI) announced the Transforming Episode Accountability Model, a proposed mandatory episode-based bundled payment model, is slated to begin in January 2026. It is among a list of alternative payment models supporting CMS's goal to have all Medicare beneficiaries in an accountable care relationship by 2030. The five-year model structure marks significant changes from previous versions and reflects how the approach to bundled payments is evolving.

Regulators move against Medicare predictive technology! The Federal Government is tightening the reins on how Medicare Advantage plans use predictive technology tools for coverage decisions. This move aims to protect patient interests. What's the story? Private insurers employ tools like nH Predict, which assesses patient data to predict their care needs and duration. However, concerns have emerged about discharges aligning suspiciously with coverage cutoffs. A spokesperson from naviHealth clarifies that the nH Predict tool is meant to develop personalized post-acute care plans and that length-of-stay predictions are estimates. New rules set for January will mandate insurers to base medical necessity determinations on individual circumstances rather than relying solely on algorithms. They must still adhere to Medicare coverage criteria and involve healthcare professionals in coverage denials. The Federal Government plans to monitor compliance through audits and enforce penalties if needed. Medicare Advantage is a crucial program, and these changes aim to ensure it delivers equitable and patient-centric care. What are your thoughts on this move? Let me know in the comments below. Vanaraj Baulraj Massoud Alibakhsh Naeem Kayani #MedicareAdvantage #HealthcareTech #PatientCare #HealthPolicy