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medicare medicaid


Tanya Zucconi, left, COO of ZGM, and Tina Burbine, vice president of care innovation at Healthlink Advisors, speak at the HIMSS22 conference in Orlando. Photo: Jeff Lagasse/Health Financing News ORLANDO — Health care organizations, from payers to providers, have repeated a common refrain in recent years: providing the right care in the right place at …

In a pair of related decisions in Hayes v University Health Shreveport, LLCand Nelson v. Ochsner Lafayette Generalthe Louisiana Supreme Court ruled on Jan. 7 that private employers in Louisiana can mandate COVID-19 vaccines for their employees. “[T]its court finds that the employer has the right to terminate the employees for non-compliance with the vaccination …

By Guest Author Rasa Fumagalli, JD, MSCC, CMSP-F – Director of MSP Compliance Services In Penelope Stillwell v State Farm Fire and Casualty Co., et al. (2021 WL 4427081), a plaintiff seeks to impose primary payor status on a post-settlement liability insurer via a qui tam action in federal district court. The United States District …

United States: Louisiana employers may be able to fire unvaccinated workers under employment-at-will doctrine January 14, 2022 Ogletree, Deakins, Nash, Smoak and Stewart To print this article, all you need to do is be registered or log in to Mondaq.com. In a pair of related decisions in Hayes v University Health Shreveport, LLC, and Nelson …

During Tuesday’s hearing in U.S. Bankruptcy Court, nurses, doctors and other staff highlighted the impact the closure of the Astria Regional Medical Center would have on the most poor in the community. “I worry about what this means for our most vulnerable population,” said Dr Rachel Monick, who was an emergency department physician at Astria …

Dan Anders, Chief Compliance Officer, Tower MSA Partners WCI will be held December 12-15 in Orlando, Florida This is the 20th anniversary of the CMS Medicare Reserve Review (MSA) program. We thought it would be a great opportunity for participants to listen and ask questions of key policy makers. – Dan Anders, Chief Compliance Officer, …

The 2022 performance year star ratings require Medicare Advantage plans to play a greater role in preventing readmissions. Care transitions have become a major goal in improving the quality of health care and the patient experience and reducing hospital readmissions. Ineffective transfer of a patient from a health care setting (eg, patient dissatisfaction, medication non-adherence, …

British Prime Minister Boris Johnson speaks at a press conference in Downing Street … [+] Briefing room in central London on September 7, 2021. – Breaking an election pledge not to raise taxes, UK Prime Minister Boris Johnson on Tuesday announced significant new funding to address a social services crisis and pandemic outbreak of hospital …

The path to value-based care remains uncertain, but has an impact for palliative care. Providers and payers from all walks of life are taking a closer look at palliative care as the Value-Based Insurance Design Demonstration (VBID) project nears its second year. Hospices need a seat at the negotiating table in order to stay in …

This comment is from Patrick Flood, former commissioner of the Ministry of Mental Health and the Ministry of Invalids, Aging and Independent Living, and former Deputy Secretary of the Social Services Agency. He is now retired and lives in Woodbury. Recently, there has been a lot of media coverage of a report by the Centers …

Photo: Alex Wong / Getty Images The Centers for Medicare and Medicaid Services announced that it will not take enforcement action against certain payers for the payor-to-payter data exchange provision of the Final Rule of Patient Interoperability and Access from May 2020 through. ‘that the future regulations are finalized. The agency’s decision to exercise its …

The Centers for Medicare and Medicaid Services are delaying the enforcement of an interoperability provision that governs how payers are supposed to exchange data with each other, the agency said on Wednesday. “CMS’s decision to exercise discretion to apply the pay-to-pay policy until future regulation occurs does not affect other existing regulatory requirements and the …

Campaigners say Newsom let them down on one payer, but stands behind him because he represents their best chance at getting it. SACRAMENTO, Calif .– If Gavin Newsom survives the Republican-led attempt to oust him from office, the Democratic governor will face the prospect of paying back the supporters who rallied behind him. And the …

SACRAMENTO, Calif .– If Gavin Newsom survives the Republican-led attempt to oust him from office, the Democratic governor will face the prospect of paying back the supporters who rallied behind him. And the leaders of the California single-payer movement will want their due. Publicly, union leaders say they stand by Newsom because he showed political …

If Gavin Newsom survives the Republican-led attempt to oust him from office, the Democratic governor will face the prospect of paying back the supporters who have rallied behind him. And the leaders of the California single-payer movement will want their due. Publicly, union leaders say they stand by Newsom because he showed political courage during …

Photo: Joseph Sohm / Getty Images The Centers for Medicare & Medicaid Services released an assessment and summary of findings from the first two years of performance – 2018 and 2019 – of the Vermont All-Payer Model. These found promising results, indicating that the MPA and the organization responsible for Vermont care, OneCare Vermont, are …

Results include reduced Medicare costs and hospital readmissions, suggesting cost savings and improvements in care coordination Colchester, VT – The federal Centers for Medicare & Medicaid Services (CMS) released an assessment and summary of findings from the first two years of performance (2018 and 2019) of the Vermont All-Payer (APM) model, finding promising results that …

Laguna Health launches app to help patients manage their home care after discharge from hospital. The app provides post-discharge patients with access to a 24/7 care team, behavioral care providers and coaches, recovery plans, educational resources and appointments. you by chat or video. Laguna is currently in a clinical trial with NorthShore University HealthSystem in …

OneRecord, a digital health company, which enables consumers to access, aggregate and share their health data has developed a consumer health plan data component on their platform. This advancement makes searching for health plan records as accessible as searching for health care records. Aetna sits alongside a list of over 40 payers supported within OneRecord, …

This article was originally published here Ann Transl Med. 2021; 9 (13): 1075. doi: 10.21037 / atm-20-5193. ABSTRACT BACKGROUND: The role of insurance on outcome in patients with non-ST segment elevation myocardial infarction (NSTEMI) is limited to contemporary times. METHODS: From the national inpatient sample, adult NSTEMI admissions were identified [2000-2017]. The expected primary payer …

Study Design: For our quantitative analyses, we employed a pre-post study design with a comparison group using enrollment data, Medicare fee-for-service claims data, and Medicaid managed care and fee-for-service claims data, covering the period 2 to 4 years before Medicare joined the state patient-centered medical home initiatives through December 2014. We used difference-in-differences (DID) regression …

Author – Search by Author –Adele L. Towers, MD, MPH, FACP Ahmed Abuabdou, M.D., MBAAlba Kuqi, MD, RHIA, CDIP, CCS, CSMC, CICA, CRCR, CCDS , CCMAlixis SmithAllen R. Frady, RN, BSN, CCS, CCDS and Rob Kopec, MDAllen R. Frady, RN, BSN, CCS, CCDS, AHIMA Approved ICD-10-CM/PCS TrainerAndrea Clark, RHIA, CCS, CPC-HAndres Jimenez, MDAndrew H. Dombro, …

This commentary is from Richard Slusky of South Burlington, who was CEO of Mount Ascutney Hospital and Health Center in Windsor from 1982 to 2010. After his retirement, he served as Director of Payments Reform for the Green Mountain Care Board for six years. . He is now the owner of Slusky Consulting LLC. This …

Hospitals are advised to provide a choice for patients in terms of nursing homes, home care agencies, acute long-term care hospitals and inpatient rehabilitation facilities. It has now been more than 18 months since the Centers for Medicare & Medicaid Services (CMS) updated the terms of participation in discharge planning, but we still do not …

PLANO, Texas, June 22, 2021 / PRNewswire / – Payer Compass, a leading provider of healthcare reimbursement technology and price transparency solutions, working with Spectrum Equity, a private equity firm focused on the economy of information, and Health Enterprise Partners (HEP), a healthcare-focused investment firm, today announced the appointment of Doug williams as an independent …

State Auditor Doug Hoffer speaks at a press conference in South Burlington on October 20, 2020. Photo by Glenn Russell / VTDigger The administrative costs of running OneCare Vermont, the company that enacts statewide health care reforms, are greater than the Medicaid savings that are attributed to its efforts, according to a report released Monday …

PLANO, Texas, June 15, 2021 / PRNewswire / – KLAS Research cited ZeOmega’s industry-leading population health management (PHM) platform Jiva as a leader in payers for configurability, ease of use, Superior API, integration and customer support. The full report can be read here. The KLAS report states, “High performing ZeOmega customers report that the vendor’s …

Leveraging quality data and education when building relationships with payers will be critical to success as hospices will begin to work as part of the Value Based Assurance Design (VBID) demonstration. , often referred to as the Medicare Advantage carve-in hospice. The program started small in its first year, with 53 participating health plans, but …

By guest author Rasa Fumagalli, JD, MSCC, CMSP-F – Director of MSP Compliance Services Medicare secondary payer (MSP) compliance settlement terms used by defendants are often too broad in nature. Recent opinion, Kupolati v. Village of Timber Creek Association, 2021 NJ Super. Unpublished. LEXIS 7 (App. Div. 5 Jan. 2021) and Abate v. Wal-Mart Stores, …

Left to right, Governor Phil Scott, Social Services Secretary Mike Smith and Director of Health Care Reform Ena Backus. Photo by Mike Dougherty / VTDigger Almost five years after the state ushered in the all-payer model to change the way health care is paid, only 2% of care in Vermonters is funded under the new …

A recent study published in the American Journal of Managed Care found that providers’ use of an electronic health record shared between inpatients and outpatients was associated with a move towards follow-up through a combination of telemedicine and ambulatory laboratory tests, with no difference in 30-day emergency room visits. “The timely availability of clinical information …

CMS sent a warning to Vermont last week calling for a restart of its all-payer model, which has not met its participation or savings targets, according to the Digger VT. In Vermont’s all payers model, Medicare, Medicaid, and commercial insurers pay for services on a per patient basis instead of fee-for-service. CMS found that for …

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CarePort Health, which develops software for care transitions, announced a new tool, CarePort Connect for Interoperability, which it says is designed to help hospitals comply with the new Centers for Medicare final interoperability rules and Medicaid Services. WHY IS IT IMPORTANT CMS’s amended conditions of participation require hospitals participating in Medicare and Medicaid to send …

The Centers for Medicare & Medicaid Services (CMS) released a final rule Thursday that changes discharge planning requirements for home care providers. Overall, the changes are part of CMS’s efforts to make patients a more active part of their care transitions out of the hospital and into other settings. “This respects President Trump’s executive order …

When hospitals implement programs to optimize patient recovery after surgery, healthcare costs go down and patients experience better outcomes. One of the main benefits of the programs – known as Enhanced Recovery Pathways – includes shorter hospital stays. But thoracic surgeons are often reluctant to release patients in an accelerated time frame for fear that …

Discharge planning is fraught with challenges for hospitals, according to a new report, but effective communication and adaptability can help providers avoid them. The United Hospital Fund, a New York-based nonprofit focused on improving the healthcare system, surveyed frontline staff and administrators at eight New York metro area hospitals to get a better picture of …

Upon discharge from hospital, uninformed patients often face time-pressed decisions about finding a suitable post-acute care provider. Discharge from hospital to a post-acute care setting is often one of the most daunting challenges patients and their families face. a valued one in five hospitalized patients is referred to post-acute care facilities such as skilled nursing …

Credit: Google Street View The Centers for Medicare and Medicaid Services announced that they are expanding their all-payer model in Maryland to include outpatient services, in its first test to keep a state fully at risk for the total cost of care for Medicare beneficiaries . Maryland’s all-pay model was launched in 2014 and has …

Three-month readmission rates for children hospitalized with acute asthma fell when families received a full pre-discharge education, according to a study published in the Journal of Pediatrics. In fact, it was the only component of exit groups that was strongly associated with a decline in readmissions. Under federal law, the Centers for Medicare and Medicaid …