Practice Management
Changes in the way the Centers for Medicare & Medicaid Services (CMS) pays for primary care will push roughly $140 million to providers next year—with provisions in a new rule bringing another $60 million for a total of $200 million above 2016 payments. There may be even more coming down the road, as CMS says several coding and payment changes could eventually lead to as much as $4 billion or more being funneled into care …
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The Urgent Care Association (UCA) sent a letter to the Centers for Medicare and Medicaid Services (CMS) in favor of lowering the copay patients would be responsible for when visiting an urgent care visit, effective in 2018. The changes would affect the cost-sharing structure for “standardized options” (ie, Simple Choice plans) that plan issuers offer in the individual insurance marketplace. Standardized options are intended to simplify the consumer plan selection process; each has a single …
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The Urgent Care Association (UCA) has officially filed comments with the Centers for Medicare and Medicaid Services (CMS), supporting a proposal to modify the “24/7” access requirements for providers who plan to bill Medicare for Chronic Care Management (CCM) codes. According to UCA, the new language will allow primary care providers “to more easily meet the CCM billing requirements if they contract with urgent care centers for their patient’s acute care needs, including evenings and …
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Major changes are afoot for urgent care centers that treat patients under Medicaid and the Children’s Health Insurance Program (CHIP), thanks to a new rule the Centers for Medicare and Medicaid Services (CMS) is imposing. In addition to new requirements for insurers, the rule also creates new compliance and administrative burdens that could affect revenue for medical practices (eg, requiring care coordination between different settings and institution of quality-rating systems and allowing states to encourage …
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The aging population—clearly not a controllable factor—is high on the list of factors that will continue to drive up healthcare spending over the next decade, according to the just-released 2016 National Health Expenditures Report from the Centers for Medicare & Medicaid Services (CMS). National healthcare spending is projected to grow at a 5.8% annual rate, starting last year through 2025. If accurate, that means healthcare spending will rise from 17.5% in 2014 to 20.1% as …
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William Rodney, MD couldn’t jump fast enough when he found out the Affordable Care Act (ACA, or “Obamacare”) would be raising Medicaid primary care payments to Medicare levels. His urgent care practice (featured here previously; see One Year In, Latino-focused Clinic Doubles in Size) took in enough additional fees to create an outreach clinic for bilingual uninsured patients and to provide x-rays, ultrasound, and other services for underserved communities in Tennessee. Now he’s worried about …
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Acting Centers for Medicare and Medicaid Services administrator Andy Slavitt has acknowledged that Healthcare.gov, the platform through which previously uninsured Americans have accessed coverage under the Affordable Care Act (ACA, or “Obamacare”), has “failed millions” since its launch more than 2 years ago. While he claims inherent problems in the system have been fixed, he says he recognizes the consequences of clunky EHR systems, low reimbursements, burnout, and various compliance requirements for primary care providers—consequences …
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The Centers for Medicare and Medicaid Services (CMS) calls it a brand-new platform, while skeptics are saying it’s just the same-old structure with a fresh coat of paint. Either way, CMS is rolling out the Quality Payment Program, which it says will ease documentation requirements for physicians while also providing new opportunities to earn bonuses by providing quality care. Under the program, physicians can receive Medicare reimbursement by participating in either the Merit-Based Incentive Payment …
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Medicare was overbilled by 12.1% in 2015, thanks to improper fee-for-service reimbursements in 21 states, according to the Centers for Medicare & Medicaid Services (CMS). That’s up from 8.6% just five years ago, making it one of the highest error rates in history. Louisiana was the worst offender, with an overbilling average of 19.4%—equating to over $1.2 billion in excess fees. Texas and Georgia also showed over a billion dollars in overcharges to Medicare last …
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A new ruling from the Centers for Medicare & Medicaid Services (CMS) standardizes the responsibility of state Medicaid agencies when it comes to telemedicine, aiming to ensure that “proper access to particular healthcare services can be ensured.” Those assessments would include the needs of patients, as well as time, distance and access afforded by telemedicine. Each state will be responsibility for policing itself by evaluating performance of those services every three years. Once the rule …
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