McAllen, Texas is a border town in the Rio Grande Valley with a metro population of 839,000. On May 25, 2009, Atul Gawande published The Cost Conundrum in which he […]
On October 3rd, 2018 Medicare announced significant changes to the Local Coverage Determination (LCD) process. As a result, a major change to the LCD format was also announced in Change […]
The new year is upon us: Are you ready for the 2019 Value-Based Purchasing Program? Eric Sorenson and Cheryl Manchenton will help you get up to speed.
When it comes to reducing Hospital Associated Infections (HAIs), where should your organization focus its efforts?
On February 9, a new telehealth bill was signed into law that expands coverage for accountable care organizations (ACOs), improves flexibility for telehealth use under Medicare Advantage plans, and allows […]
Recently, I reviewed the Medicare Hospital Value-Based Purchasing (VBP) scores for three hospitals recognized nationally for outstanding care and patient safety. They didn’t look good. The ratings for clinical outcomes […]
I attended the January 9, 2018 CMS Medicare Learning Network conference call covering the logistics of the settlement process offered by CMS for providers with pending appeals. This impacts: “The […]
L. Gordon Moore and Donna Smith discuss how appropriate documentation and coding of hierarchical condition categories (HCCs) can have a significant impact on payment in a value-based system.
In 2012, the Centers for Medicare and Medicaid Services (CMS) began its Hospital Readmissions Reduction Program (HRRP). The program, included in the Affordable Care Act, was designed to improve post-acute […]
Medicare beneficiaries are constantly bombarded with mail, emails and advertisements from insurers encouraging them to buy a Medicare supplemental insurance policy. It seems odd that there is such an aggressive […]
Last fall, I wrote a blog on providers who continue to bill cost-sharing co-payments to “dually eligible” (Medicare/Medicaid) patients. This practice is not allowed; providers and suppliers are barred from […]
This month, Inside Angle blogger Rebecca Caux-Harry discusses E/M coding guidelines with Andee Andriole, 3M senior manager of outpatient consulting services. Andee: So, I guess we need to start thinking […]