Quarles & Brady LLP’s Post

Changes are underway in how states are handling providers’ offshoring of data under the Medicare and Medicaid programs. This article describes the October 1, 2024 changes by Arizona to further limit providers’ and payers’ offshoring options. Stakeholders should review their practices and downstream contracts to ensure compliance with the updated language and prepare for similar regulatory interest in other states. #medicaid #medicare #healthlaw #dataprivacy #providers

NEMT providers, navigating Medicaid electronic billing regulations is key to compliance and operation optimization. Check out these strategies to stay updated on the latest rules and tips for success in the dynamic healthcare industry. Read more: https://lnkd.in/g8wS3-iX #NEMT #MedicaidBilling #HealthcareRegulations

The Centers for Medicare & Medicaid Services (CMS) Burden Reduction Rule, designed to streamline administrative processes in healthcare, promises significant financial implications, particularly concerning electronic prior authorizations (ePAs). As the healthcare industry transitions from manual to electronic systems, the Burden Reduction Rule aims to simplify and expedite prior authorizations, offering substantial cost savings and efficiency improvements for healthcare providers, payers, and patients. #Healthcare #Interoperability #BurdenReduction #FinancialImplications #ePA https://lnkd.in/dJnJWFpc

Dive into the intricacies of Medicare Advantage payment models! Our latest article unpacks the coding practices, intensity adjustments, and value of accurate coding in MA. Discover how these factors shape healthcare delivery and impact payments, and stay informed about the evolving landscape of Medicare reimbursement. #MedicareAdvantage #HealthcarePayment #CodingIntegrity #emedlogix #hcccoding #riskadjustmentcoding #riskadjustment #medicare #medicaid #aiinhealthcare #medicalcoding #codingintensity #healthcare #healthinsurance https://wix.to/ZwV9hAZ

"Exciting news for healthcare accessibility! 🎉 The federal government has just issued a final regulation aimed at simplifying and automating the prior authorization process, improving transparency for certain payers. This move comes amidst growing concerns about consumer barriers to care. Key takeaways: - The regulation will standardize prior authorization standards across various insurance programs overseen by CMS. - Electronic processes will be utilized to streamline prior authorization reviews, promising faster outcomes. - New transparency requirements will inform enrollees about services requiring prior authorization and provide aggregate data on claim denials. - Time frames for decision-making will be shortened for some plans. While this is a positive step forward, there are still areas for further evaluation. Stay tuned as we navigate these changes together! #HealthcareAccess #PriorAuthorization #CMSRegulation #HealthcareTransparency"

In the latest healthcare debate, Senator Sheldon Whitehouse is shaking things up with a bold new proposition aimed at simplifying the lives of doctors and patients. He's challenging the status quo on Medicare prior authorization, proposing that insurance companies must get approval from CMS before requiring it. This move could ease the burden on healthcare professionals and provide quicker, more efficient care for patients. With healthcare costs soaring to nearly $200 billion yearly due to billing and insurance-related complexities, it's time for a change. #Medicare #PriorAuthorization https://lnkd.in/ggek9V7A

CMS has introduced Change Healthcare/Optum Payment Disruption (CHOPD) accelerated payments to assist Part A providers and advance payments to Part B suppliers facing claims disruptions. The CHOPD accelerated and advance payments may be granted in amounts representative of up to thirty days (30) of claims payments to eligible providers and suppliers. The average 30-day payment is based on the total claims paid to the provider/supplier between August 1, 2023 and October 31, 2023, divided by three. These payments will be repaid through automatic recoupment from Medicare claims for a period of 90 days.

In the News: According to recent a Becker's Healthcare article. providers whose Medicare payments were impacted by the cyberattack on Change Healthcare have until July 12 to request advanced payments from the Centers for Medicare and Medicaid Services (CMS). CMS has provided $2.55 billion in advanced payments to 4,200 Medicare Part A providers through the program, and $717.2 million in payments to Part B providers. Read more here: https://hubs.li/Q02Ct6qs0 #hospitalfinance #changehealthcare #cyberattack #cms #medicare #medicaid #hospitalrevenuecycle #hospitalrevenue #hospitalmargins #rcm #beckershealthcare #revenuecyclemanagement

The Medicare Advantage (MA) program is facing a "great disruption" ahead of its annual enrollment period in mid-October. Key factors include increased government scrutiny, stricter Centers for Medicare & Medicaid Services regulations, and reduced payments amid rising healthcare costs. MA carriers are responding by focusing on margins over membership, reducing benefits, and exiting unprofitable markets, while strained negotiations with providers lead some health systems to drop certain MA plans. A "seven-figure" lobbying campaign is underway to highlight the benefits of MA plans. Dr. Sachin H. Jain, MD, MBA, CEO of SCAN, emphasizes that stability in benefits will be more attractive to beneficiaries than innovation. MA carriers must enhance care management, focusing on chronic condition management and reducing hospitalizations. Competition will shift to effectiveness and service quality, brokers will play a more prominent role, and stronger, focused partnerships will become more valuable than broad collaborations. Our RCM and consulting professionals assist Medicare Advantage carriers by optimizing care management strategies, ensuring compliance with CMS regulations, and streamlining reimbursement processes. We help navigate provider negotiations, enhance financial margins, and offer strategic insights to maintain benefit stability and improve service quality amid shifting market dynamics. We are the One! #revenuecycle #revenuecyclemanagement #priorauthorization #medicalbilling #medicalcoding #healthcare #healthcaretechnology #accountsreceivables #denialmanagement #consulting #management #implementationpartner Becker's Healthcare

CMS finalizes the prior authorization rule. This won't go into effect till 2026. Payers will be required to include a specific reason when denying requests, publicly report certain prior authorization metrics and send decisions within 72 hours for urgent requests and seven calendar days for standard requests.  The rule also requires affected payers to implement a Health Level 7 Fast Healthcare Interoperability Resources standard application programming interface to support electronic prior authorization. #CMS #fhir #hl7 #revenuecyclemanagement #HeathcareIT https://lnkd.in/eCrxnnDT