Payment Reimbursement and Managed Care

CMS waiver for hospital-at-home designed to address COVID-19-driven capacity issues | HFMA

While it’s been rumored that the Center for Medicare & Medicaid Innovation was working on a hospital-at-home model, this is a short-term waiver designed to address COVID-19-driven capacity issues, said HFMA’s Chad Mulvany.

Chad Mulvany, FHFMA December 14, 2020

Patient visit restrictions bringing many new costs

Ongoing hospital visitor restrictions can have a range of adverse effects, potentially affecting clinical outcomes and increasing costs for health plans and providers in value-based payment models.

Rich Daly December 11, 2020

Connecticut’s launch of a bundled payment program for its employee health plan is part of an effort to save the state $185 million | HFMA

HFMA’s Chad Mulvany says some state governments, like Connecticut, have high enough volumes that COVID-19 may accelerate their adoption of value-based payment models.

Chad Mulvany, FHFMA December 10, 2020

CMS unveils the Geographic Direct Contracting model

The Geographic Direct Contracting model will test full-risk arrangements for healthcare entities serving thousands of Medicare beneficiaries within defined geographic areas.

Rich Daly December 9, 2020

Coming coronavirus surges will hit hospitals harder than earlier spikes did, disease expert says

An infectious disease expert expects hospitals to have larger COVID-19 patient surges than they’ve had to date.

Rich Daly December 8, 2020

Big value-based payment shifts may happen during a Biden administration

A Biden administration could undertake many changes to federally operated value-based payment models, say industry watchers.

Rich Daly December 8, 2020

Walmart’s plans to test narrow networks selected on quality could set stage for a shift in employer-sponsored insurance

Walmart plans a ground-breaking test of narrow networks for its employee health plan that will test both enrollee acceptance and physician cooperation.

Rich Daly December 8, 2020

Medicare phases out the inpatient-only list, backs off further 340B payment cuts

The final rule for the CY21 Medicare Outpatient Prospective Payment System will phase out the inpatient-only list but won’t implement steeper 340B cuts.

Rich Daly December 4, 2020

Medicare shifts payments toward primary care physicians in PFS final rule

The final rule for CY21 Medicare physician payment will boost evaluation and management service payments while cutting rates for services provided by many specialty physicians.

Rich Daly December 3, 2020

5 tips to safeguard 20% payment increase for treating patients with COVID-19

Healthcare organizations should be careful to ensure their practices don't put their COVID-19 payments at risk.

Lisa A. Eramo, MA December 2, 2020
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