Shadow bundles represent a novel way of structuring payments within an ACO’s attributed population. Starting in February of 2024, CMS now released detailed episode-level claims files, target prices, and summary reports on a monthly, quarterly, and annual basis. Read more: https://lnkd.in/gRDUJWkR #ACOs #SharedSavings #CMS
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CMS' proposed changes to the No Surprises Act's IDR are complex, yet, paradoxically, will likely make the process more efficient. My latest blog walks payers and providers through how the IDR would work according to the proposed rule. Complete w/ helpful timeline illustrating proposed IDR deadlines! Check it out here: https://lnkd.in/e7B8RB7h
NSA Updates: Understanding IDR Process
https://www.zelis.com
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Attention #MedicareAdvantageOrganizations: New requirements released by CMS discuss supplemental benefit encounter data submissions via EDS. Don't get caught off guard by the complexities. Learn how to navigate the process smoothly with our expert guidance. https://bit.ly/4a9ebtZ #MedicareAdvantage #supplementalbenefits #CMS #EDS
Encounter Data System (EDS) Submissions for MA Supplemental Benefits
insights.conveyhealthsolutions.com
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Vice President, Physician Advisory Solutions at R1 RCM, Advisory Board of American College of Physician Advisors and National Association of Healthcare Revenue Integrity, differentiator between acronyms and initialisms
CMS has hit a milestone after 58 years that no one has acknowledged. They are adjusting the Fiscal Intermediary Shared System (FISS) to be able to pay claims that exceed $1,000,000 and move it up to $99,999,999.99. I am not sure what was done up to now as I am sure some transplant and CAR-T cases exceeded that amount, and I know for one hospital the chargemaster amount for CAR-T is $10,800,000 so at least on the claim submission side this was possible. (Yes, one line, one CPT code, charge over $10 million but that's before the CCR adjustment 😀 ) We do amazing things in medicine today, but boy it costs a lot... https://lnkd.in/gaBW-FbT
R12155OTN.pdf
hhs.gov
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Minimizing liens and protecting future Medicare/ Medicaid benefits | Medicare Set Aside Problem Solver | Computer Software Exec | The Best is Yet to Come
Medicare sent an email earlier today with a reminder about upcoming system modernization activities. "This is a reminder that due to system modernization activities, there will be outages to the following Coordination of Benefits & Recovery (COB&R) applications and operations: - Medicare Secondary Payer Recovery Portal (MSPRP) - Commercial Repayment Center Portal (CRCP) - Benefits Coordination & Recovery Center (BCRC) and Commercial Repayment Center (CRC) Call Centers The outages are currently scheduled for the following days and times: Date: Friday, June 28, 2024, through Monday July 1, 2024 Time: 2:00 PM ET Friday through 7:00 AM ET Monday Additional Information: Call Center Will Not Be Available; Operations Will Resume on Monday, July 1 at 8:00 AM ET. We apologize for the inconvenience." Seems like all those Medicare announcements from the 1st half of 2024 are being built into the system this weekend.
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How does your team handle Part A Consolidated Billing? If you are not a SNFCB.com subscriber, I challenge you to ask your team the below questions. If they cannot answer you, it's time to take a look at www.snfcb.com and see how we can help! Our system is so much more than software and priced so affordably, any Part A SNF cannot afford to NOT subscribe. Let me know how this conversation goes and if you have any questions. My email is: support@snfcb.com 1) How many different fee schedules are there? 2) How are payments packaged by Status Indicator under OPPS? 3) When is the SNF not responsible for ambulance transport? 4) Which modifiers cause payment reductions to providers? 5) How can I get more help when Medicare Part B processes a claim incorrectly? #ConsolidatedBilling #Snfcb #PartAClaims #medicareconsolidatedbilling
Your online solution for Medicare SNF Consolidated Billing services | SNFCB
snfcb.com
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Let's Talk Reporting: Protecting Your Benefits with Proper Compliance! Are you navigating an MSA? It's crucial to fulfill reporting obligations to CMS and ensure funds are spent according to guidelines. Here's how we ensure compliance: Annual Accounting Report: Annual attestations showcase that funds are dedicated to injury-related Medicare-covered expenses. We leave no detail behind, submitting line-item information, including ICD, CPT, HCPCS, and NDC codes. Temporary Depletion Report: In case of running out of funds for the year, we inform CMS promptly, allowing Medicare to step in for injury-related treatments until the next annuity check, provided the individual is enrolled in Medicare. Permanent Depletion Report: If MSA funds are permanently exhausted, we collaborate with CMS to demonstrate appropriate spending. This prompts Medicare to take over coverage for injury-related treatments. If you have further questions or concerns, we're here to help! Reach out to us today to learn more about how Ametros can secure your settlement process and provide the support you need. #MSAReporting #SettlementBenefits #MedicareCoverage #ProfessionalAdministration
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https://lnkd.in/ekZrfvXH This 2024 CMS ruling is requiring ASCs to report quality data in a user-friendly format for public consumption. Looming financial penalties ensue for not complying! Discreet data = ShareableFORMS data = Reportable data. #yourforms #qualitydata #ASCA #outpatientsurgery
Newsroom_Navigation
cms.gov
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My clients have been worried about the Coding Intensity Factor (CIF) in ACO REACH ever since it was first announced years ago. The CIF was quite tame in 2021 and 2022, but 2023's CIF is going to hurt. This paper I wrote with Caroline Li explains what the CIF is and offers some thoughts about how it will affect REACH ACOs' financials. https://lnkd.in/g93yanH2
Interactions between the CIF and the +/- 3% risk score floor and ceiling in ACO REACH
milliman.com
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Keep your organization up to date by learning how the 2024 Physician Fee Schedule Final Rule impacts the Medicare Shared Savings Program in this Moss Adams article by me and Pat Oungpasuk. The article examines the most notable impacts to the MSSP including moving ACOs toward a digital measurement of quality, refinements to ACOs’ financial benchmarking methodology, adding a third step to the beneficiary assignment methodology and modifications to Advance Investment Payment (AIP) policies.
2024 Physician Fee Schedule Final Rule Impacts Medicare Shared Savings Program
mossadams.com
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📣 Navigating the Medicare maze? Here's your quick guide to ensuring your claims are 💯 spot-on and payment-ready! 1️⃣ Accuracy is Key: Double-check patient info like name, DOB, and Medicare ID. A tiny error can derail the entire process! 2️⃣ Full Docs or Nothing: Skimping on documentation is a no-go. Complete records are a must for seamless claim approval. 3️⃣ Coding with Precision: Get those ICD-10 and CPT/HCPCS codes right. Aim for specificity to avoid claim delays. 4️⃣ Modifiers Matter: They're not just add-ons but crucial for detailing the nuances of the services provided. Use wisely! 5️⃣ Watch the Clock: Stick to Medicare’s filing deadlines to dodge penalties. Remember, you've got a year from the service date. 6️⃣ Provider Enrollment Check: Only enrolled and credentialed providers can bill. Navigate the incident-to and split/shared billing with care. 7️⃣ Guidelines Galore: Stay updated with LCDs, LCAs, and NCDs for what’s covered and what’s not. 8️⃣ Go Digital: Embrace EDI for faster, more accurate claim submissions. Say goodbye to paperwork errors! 9️⃣ Integrity First: Keep your billing honest—no upcoding or unbundling. Medicare’s watching! 🔟 Be Responsive: Quick replies to Medicare’s requests can mean faster claim processing. 💡 Stick to the guidelines and watch your Medicare claims process smoothly and accurately. Here’s to getting it right and getting paid! 💰📈 #HealthcareBilling #MedicareClaims #MedicalCoding #HealthcareTips
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