The van Halem Group’s Post

Opportunities to impact reimbursement are not typical for patient access leaders, but the Medicare Physician Fee Schedule Final Rule may change that outlook. As of January 1, 2024, there are confirmed payments on behalf of different types of Medicare beneficiaries. Patient Access Collaborative Founder & Executive Director, Elizabeth Woodcock, DrPH, MBA, FACMPE, CPC, points that although the government’s ruling relates to Medicare exclusively, decisions from the Centers for Medicare & Medicaid Services set a precedent for reimbursement trends and has shared her findings in our newest blog post. Read here: https://lnkd.in/ey9Mmw8p #medicarebenficiaries #reimbursement  #healthcare #patients

Without Congressional action to extend current Medicare telehealth flexibilities, the Centers for Medicare & Medicaid Services (CMS) may need to establish Medicare payment policies (including for telehealth) for calendar year (CY) 2025 under the assumption these flexibilities will not exist. This is evident in the Medicare Physician Fee Schedule proposed rule, which was released just over a month ago. This uncertainty around Medicare telehealth flexibilities is already creating issues for providers and patients. PAVC and other stakeholders recently sent a letter to House and Senate leadership, urging quick action on legislation to extend current Medicare telehealth flexibilities, in light of the fast-approaching year-end deadline. Read the full letter here: https://lnkd.in/eS4Qu6Mp #Telehealth #VirtualCare #Medicare #HealthPolicy

In NAACOS' response to the 2025 #Medicare Physician Fee Schedule proposed rule, we acknowledge and appreciate that many of the #physicianpayment and MSSP policies in the proposed rule will enable providers to deliver comprehensive care management and provide enhanced beneficiary care services, including policies to create payment for advanced #primarycare, receive shared savings payments in advance, and provide a health equity benchmark adjustment in MSSP. While we support these changes, we are concerned that the Centers for Medicare & Medicaid Services (CMS) has not addressed two key policy issues that, if left unaddressed, will significantly hamper participation in MSSP and impede CMS' goal to have all beneficiaries in accountable care models by 2030. We urge CMS to address: 1. Flawed approaches to quality measurement and interoperability 2. Financial benchmarks and long-term viability Read more in our comments: https://lnkd.in/e9vaf84y

When payers deny prior authorization requests today, the information they provide often varies from one payer to the next. The 2024 Prior Authorization Final Rule from Centers for Medicare & Medicaid Services will (among other things) require payers to provide a specific reason for denying a prior authorization request, regardless of the method used to send the request (calls, email, standard transactions, etc.). Today’s Office Hours guest Jennifer Glockzin, Senior Manager Patient Access, shares updates on the 2024 Prior Authorization Final Rule. Learn about the rule’s impact to providers and payers for care coordination. Spoiler alert – it involves reduced administrative burden! Register here: https://hubs.li/Q02ld28r0 #HealthcareTech #PatientAccess #RCMAI #RCMAutomation #PriorAuthorization #PatientAccessAI #PriorAuthorizationFinalRule

The final evaluation of the Comprehensive Primary Care Plus (CPC Plus) initiative, aimed at transforming primary care, showed that, despite increased financial and tactical support, participating practices did not demonstrate significant reductions in Medicare expenditures. The study found no significant differences in adjusted total expenditures before accounting for enhanced payments, and after accounting for enhanced payments, total expenditures were significantly higher in CPC Plus practices, highlighting challenges in achieving cost savings through primary care transformation. Explore the findings on primary care reform here: https://snip.ly/r7e1ym #PrimaryCare #HealthcareReform #Medicare #PatientCare

The recent updates from the Centers for Medicare & Medicaid Services (CMS) have shaken up the medical billing landscape. These new guidelines are set to impact how we handle billing, especially for small and medium-sized practices. It's crucial to stay informed about these changes to ensure compliance and maintain smooth operations. What do these updates entail and how they can affect our day-to-day processes? Let’s navigate these changes together, ensuring our practices are ready and resilient. https://lnkd.in/gfdkaZXQ #CMSGuidelines #MedicalBilling #HealthcareCompliance #MedicareBilling

Congress Passes 1.68% Physician Fee Schedule Provider Relief Congress has agreed to a 1.68% increase to the physician fee schedule beginning this week. This is some good news for providers, but it still doesn’t close the gap on the 3.37% cut initiated by the Centers for Medicare & Medicaid Services last fall which went into effect on January 1, 2024. The most recent 3.37% cut is just one of a series of cuts that Medicare B providers have faced, totalling nearly 10% over the last 4 years. Industry underfunding has serious implications for seniors and providers, including access to care, inability to cover rising practice costs and growing staffing shortages. #Healthcareadvocacy is needed now more than ever! Healthcare advocates and providers need to ask Congress to: 1) Provide for a temporary exemption to the 15% therapy assistant differential for providers treating Medicare beneficiaries in rural and/or medically underserved areas. 2) Remove mechanisms that annually create significant unpredictable reductions in pay so that providers receive payment that covers the cost of care now and in the years to come. Advocating takes only a minute using this prepopulated template. Email your congress member. Take an additional minute to personalize your message and make an even bigger impact! https://p2a.co/TMQNLAZ #Regulatory #PowerbackRehab

Earlier this month, Healthsperien released a detailed summary of the calendar year (CY) 2024 Medicare Physician Fee Schedule (MPFS) and Quality Payment Program (QPP) final rule to our clients. Released on November 2, this final rule includes updates on policy changes for Medicare payments under the Fee Schedule and other Medicare Part B issues on or after January 1, 2024. The Centers for Medicare and Medicaid Services (CMS) notes this final rule is one of several final rules that reflect a broader Administration-wide strategy to create a more equitable #healthcare system that results in better access to care, quality, affordability, and innovation. Visit our website to read the comprehensive summary and explore our other resources: https://lnkd.in/gVWg64g3 #medicare #finalrule #healthpolicy #CMS

It is critical that all providers get on board with advocating for reimbursement.

He’s back! Chris Emper, our government affairs advisor, shares the latest in healthcare policy in a new #DCUpdateWithChris. In today’s episode, Chris explains how the Centers for Medicare & Medicaid Services (CMS) is working to improve the prior authorization process—great news for providers and patients. #DCUpdateWithChris #healthcarepolicy #healthcarenews #healthcare