We’ve assembled the latest news for healthcare revenue cycle leaders to help you stay on top of industry challenges and adapt your revenue cycle management services.
CMS Launches VBC Strategy Blog
The agency has released a new blog that includes a progress report on its value-based care strategy. The blog also includes CMS’ strategy on advancing value-based payment, growth in accountable care, alignment across payers, and the promotion of equity. This change could influence providers to change the way they engage with revenue cycle management companies. [1]
OIG Impact Brief on Medicare Advantage for Prior Authorization
The OIG has released its Impact Brief, highlighting the impact of oversight of prior authorization under Medicare Advantage (MA). A 2022 report revealed that the agency reported that MA organizations were sometimes delaying or even denying MA enrollees access to services by misusing prior authorization. [2]
Biden Administration Announces Initiative That Increases Investments in Primary Care
The current administration announced a voluntary model that intends to empower PCPs that are members of eligible ACOs. This would help them in their treatment of people with Medicare by incentivizing team-based, person-centered, along with innovative and proactive care. It also has a goal of promoting competition in healthcare. Offices interested in these investments should look for the best medical billing company as support. [3]
CMS Introduces Fiscal Year 2025 Inpatient Rehabilitation Facility Prospective Payment System Proposed Rule
CMS has issued the rule that covers a proposed update to Medicare payment policies under the IRF PPS and the IRF QRP. It has been published in alignment with legal requirements to update the payment policies for IRFs annually. [4]
Eighth Annual Evaluation Reporting of Independence at Home Demonstration Released by CMS
The agency has released the eighth annual report on the valuation of the Independence at Home Demonstration (IAH). The IAH is mandated by Congress, testing whether payment incentives for provision of home-based primary care for Medicare recipients with multiple chronic conditions is effective for reducing healthcare spending through Medicare. This could impact home health coding across the country. [5]
CMS Publishes FISS EUCR
The agency has published the Fiscal Intermediary Shared System (FISS) User Enhancement Change Request (UECR), rescinding and replacing Transmittal 12309. The original transmittal was issued as a modification to the FISS to set the expiration date of a UTN on the Prior Authorization Detail Screen. It is effective April 1, 2024. [6]
Second Annual Evaluation Report for the Primary Care First Model Released by CMS
The agency has released the second annual report on evaluating the Primary Care First Model (PCF). The PCF has a goal of improving quality and the patient experience of care, all while reducing spending through an increase in patient access to advanced primary care services. This change could cause many to consider medical coding consulting. [7]
FAQ on Social Needs Released
CMS has published an FAQ on services intended to address health related social needs. This FAQ clarifies billing practices for items including social determinants of health risk assessment, community health integration services, caregiver training services, and principal illness navigation services. This can impact anyone interested in physician billing services. [8]
Recent Cases in Healthcare Billing Fraud
This article features a list of cases in healthcare billing fraud across the U.S., including a man and woman who submitted $125 million in fraudulent claims and a scheme that involved $20.7 million in false claims, highlighting the benefits of outsourcing medical billing. [9]
References
[1] D. Jacobs, P. Rawal, M. Schreiber, D. L. Hughes, E. Fowler and M. Seshamani, “Update On The Medicare Value-Based Care Strategy: Alignment, Growth, Equity,” Health Affairs, 14 March 2024. Available: https://www.healthaffairs.org/content/forefront/update-medicare-value-based-care-strategy-alignment-growth-equity.
[2] HHS Office of Inspector General, “Medicare Advantage Prior Authorization,” 18 March 2024. Available: https://oig.hhs.gov/documents/impact-briefs/9820/Medicare%20Advantage%20Prior%20Authorization%20Impact%20Brief.pdf.
[3] U.S. Centers for Medicare & Medicaid Services, “Biden-Harris Administration Announces New Initiative to Increase Investments in Person-Centered Primary Care,” 19 March 2024. Available: https://www.cms.gov/newsroom/press-releases/biden-harris-administration-announces-new-initiative-increase-investments-person-centered-primary.
[4] U.S. Centers for Medicare & Medicaid Services, “Fiscal Year 2025 Inpatient Rehabilitation Facility Prospective Payment System Proposed Rule (CMS-1804-P),” 27 March 2024. Available: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2025-inpatient-rehabilitation-facility-prospective-payment-system-proposed-rule-cms-1804.
[5] U.S. Centers for Medicare & Medicaid Services, “Independence at Home Demonstration – Year Eight Evaluation Report,” February 2024. Available: https://www.cms.gov/priorities/innovation/data-and-reports/2024/iah-year8-eval-report-fg.
[6] “Pub 100-20 One-Time Notification Transmittal 12549 (Change Request 13284),” 19 March 2024. Available: https://www.cms.gov/files/document/r12549otn.pdf.
[7] U.S. Centers for Medicare & Medicaid Services, “Evaluation of the Primary Care First Model – Second Annual Report,” February 2024. Available: https://www.cms.gov/priorities/innovation/data-and-reports/2024/pcf-second-eval-rpt.
[8] U.S. Centers for Medicare & Medicaid Services, “Health-Related Social Needs FAQ,” March 2024. Available: https://www.cms.gov/files/document/health-related-social-needs-faq.pdf.
[9] A. Cass, “Healthcare billing fraud: 10 recent cases,” Becker’s Hospital Review, 11 March 2024. Available: https://www.beckershospitalreview.com/legal-regulatory-issues/healthcare-billing-fraud-10-recent-cases-15.html.
