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March 31, 2020

CMS Issues Blanket Waivers of Stark Law Related to COVID-19 Pandemic

UPDATED April 8, 2020

On March 29, CMS issued blanket waivers of the Physician Self-Referral Law (commonly known as the “Stark Law”) to cover financial relationships and referrals related to the COVID-19 pandemic in the United States.  

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Topics: Stark Law

March 26, 2020

How Does COVID-19 Telehealth Expansion Affect Providers?

UPDATED April 7, 2020: There have been updates to the proposed rule which can be found here

Telehealth services have become even more critical in caring for patients as the COVID-19 pandemic quickly evolves. In order to temporarily remove barriers to practice telehealth, the Federal Government and many States are making sweeping changes in Telehealth Waiver provisions. 

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Topics: Telehealth, COVID-19

January 23, 2020

Recent CMS Rulings Simplify Payments for Transitional Care Management

In recent years, the use of care management services to provide better patient outcomes has gained momentum. Contributing to this momentum is a desire to generate greater transparency around patient behaviors in Post-Acute Care settings. This setting was the first focus area for the creation of care management services.

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Topics: Physician Compensation, Patient Care, Managed Care Organization, CMS

November 21, 2019

Recent Legislative Impacts to Telemedicine in Care Delivery

Legislative support is growing for the reimbursement of care delivery via telemedicine. The Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG) have recently made final and proposed rule changes to stimulate greater use and access for telemedicine delivery. These changes mean that for healthcare providers all around the United States, telemedicine will become a greater strategic focus.

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Topics: Telecommunications

October 03, 2018

Price Transparency: Go Deeper Than Compliance with New CMS Rule

Chalk one up for advocates of consumerism. CMS is encouraging price transparency with its FY2019 Inpatient Prospective Payment System (IPPS) rule released in August.

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Topics: Price Transparency, Hospital Chargemaster, IPPS

June 07, 2018

How To Find the Upside in Downside Risk

Wary of factors that are outside their control, almost two-thirds of healthcare leaders would rather bail out of their accountable care organizations (ACO) than make the leap to a model that includes downside risk.

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Topics: Value-Based Care

September 15, 2017

CMS May Want Their Money Back

The old adage, "Money can make you do crazy things," can easily be applied to both our personal and business lives. Within the healthcare industry, HITECH incentive payments were offered by the U.S. government several years ago to implement electronic health record (EHR) systems at hospitals and other healthcare organizations. In order to qualify for these incentive payments, healthcare organizations were required to carry out regular security risk assessments to show they were meeting the HIPAA Security Rule requirements. While a large number of healthcare organizations properly followed the rules and carried out the security risk assessment required, a select number received the incentives without doing so.

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Topics: Electronic Health Records

September 01, 2017

Are Your Medical Devices Secure?

If your hospital or clinic uses a Windows 7-based version of a Siemens PET/CT or SPECT system, it could be vulnerable to attack by a relatively low-skill hacker, according to a July 26 security advisory from the company.

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Topics: Electronic Health Records

August 25, 2017

Why Your Hospital or Physician Practice Must Embrace Risk

Risk tolerance is an interesting thing. Those who make the biggest bets often are actually control freaks—maybe because they know that, by having a strong grasp on the factors that influence the deal, they greatly increase the likelihood that they will come out ahead.

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Topics: Value-Based Care, Cost Accounting, MACRA Summary

July 27, 2017

Is It Time to Transition From CCMAs to APMs?

A Bridge for Healthcare Reform

Over the past decade, clinical co-management arrangements (CCMAs) have risen in popularity as a means to achieve a more integrated care delivery model. CCMAs have often been touted as an interim strategy to bridge hospitals to newer emerging models, but many hospitals have yet to cross that bridge.

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Topics: Healthcare Reform, Payment Models, APMs

June 15, 2017

A Primer on Operationalizing Alternative Payment Models

 

MACRA’s anticipated future impact on the healthcare industry has many provider organizations contemplating what actions and resources are necessary to participate in alternative payment models (“APMs”). Provider organizations facing the immediate options of getting involved with a CMS or commercial APM have significant operational decisions to make that will impact the future make-up of their organizations. Today we will discuss some of the considerations in preparing for APM participation.

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Topics: APMs, MACRA Summary

May 25, 2017

A Prescription for Reviving Your Financial Outlook: A Medicare Risk Strategy

Healthcare providers face $42 billion in cuts in 2018 under Medicare’s traditional fee-for-service program. Those payment rate reductions, which were put in place by the Affordable Care Act, are scheduled to cut deeper with each year—from $53 billion in 2019 to $86 billion in 2022.

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Topics: Fee-for-Service, Value-Based Care

April 28, 2017

MedPAC to US Congress: Act Now to Reform Post-Acute Payments

The post-acute care (PAC) sector is a target for significant change. Facing criticism of excessive spending, the sector is facing an overhaul of the payment system that, when it finally arrives, could disrupt the healthcare landscape once again.

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Topics: Fee-for-Service, Payment Models

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