CMS Announces $8 Million Grant For Quality Improvement

The Centers for Medicare & Medicaid Services’ (CMS) Quality Improvement Organization (QIO) program made a recent announcement of an additional eight million dollars in funding for the Special Innovation Projects (SIP). This project support and increase the collaboration among healthcare providers and partners and Quality Innovation Network (QIN-QIOs). The new round is built on the…

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OIG Report Highlights Improper Medicare Payments Offered To Prisoners

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a report on Oct 7 that documents about $34 million in payments that are improperly made by CMS to cover the medical services that are rendered to the Medicare beneficiaries who are imprisoned. Medicare usually does not pay for the services…

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HHS’ Recently Released Rule Will Offer More Authority To ONC

The recently released final rule from the Department of Health and Human Services (HHS) has enabled the Office of the National Coordinator for Health Information Technology (ONC) to become more powerful for review oversight and for the certification of electronic health information products including EHR (Electronic Health Record) product. The proposed rule establishes the authority…

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GAO Asks For Meaningful Unified Quality Measures

The recently released report from the Government Accountability Office (GAO) clarifies that the officials are looking for a much better or more relevant unified quality measures across all the healthcare programs in the country. One of the major reasons for this is that the health plans (both commercial and government), which currently exist in the…

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Specificity Grace Period For ICD 10 Ends

ICD-10 replaced ICD-9 coding system last year, and October 1, 2016 marked one year of the substitution. Reports say that the latest ICD-10 coding model increased the amount of data that is captured by the diagnostic codes. It also enhanced the specificity regarding disease severity and offered more data on specific anatomy the condition or…

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Medicare Physician Fee Schedule Rules For 2017 Finalized

The Centers for Medicare and Medicaid Services has released updates to their different Medicare payment systems. In a recent move, CMS published the final rules for Hospital Outpatient Prospective Payment System (HOPPS) and the Medicare Physician Fee Schedule (MPFS), within a day of each other. The detailed summary of 2017 Medicare Physician Fee Schedule Final…

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CMS Issues Final Rule For Quality Payment Program

The final rule was released by the CMS on October 14, 2016. This rule will implement a new Quality Payment Program (QPP) established by the Medicare Access and CHIP Reauthorization Act (MACRA). The much-disliked Medicare Sustainable Growth Rate Formula (SGR) was revoked by the MACRA in order to determine the updates to the Medicare Part…

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How Advanced APMs Would Affect ECs

Recent reports say that one-third of the ECs will be exempted from MIPS reporting, because these ECs fall below the “low volume threshold.” This means that those ECs who submit the claims to Medicare for hundred or less patients or in Medicare Part B allowed charges or who submit claims for 30,000 dollars are free…

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Past Challenges Might Put ACA Open Enrollment At Risk

It is reported that ACA open enrollment is advancing even though many of the past challenges linger on, and not just the customers, but the insurers too are facing challenges. Enrollment of the younger individuals has lagged for all the three years the exchanges have been introduced, and we can assume that only a few…

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ACA Open Enrollment Advances Even Though Past Challenges Remain

Customers started to shop for health insurance on federal and state exchanges that were formed under the Affordable Care Act (ACA) on November 1 for the insurance coverage that begin in 2017. As per the estimates of the Obama Administration, 1.1 million new people will enroll in a plan this year, and the total enrollment…

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