Why Medicare Advantage is lacking on cancer care
FierceHealthIT
NOVEMBER 21, 2023
A City of Hope analysis found that Medicare Advantage members faced a delay of two weeks or more between diagnosis and their first course of therapy.
Free Course Available Now: Remote Patient Monitoring Module!
South Central Telehealth Resource Center
MAY 12, 2021
Identify RPM medicare CPT codes. Take This Course! The post Free Course Available Now: Remote Patient Monitoring Module! This interactive module helps participants: Define Remote Patient Monitoring (RPM). Identify patient populations and use cases for RPM. Discuss RPM conceptual models. Develop clinical workflows.
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Trending Sources
United Healthcare Reverses Course to Cover Tandem Pumps
Insulin Nation
AUGUST 4, 2020
This change affects individual and group payer plans as well as Medicaid and Medicare Advantage. The post United Healthcare Reverses Course to Cover Tandem Pumps appeared first on Insulin Nation. On July 1st, United Healthcare announced they will now offer coverage for Tandem’s t:slim X2 insulin pump. A Step In the Right Direction.
Editor's Corner—Fierce Healthcare's 10 most-read stories of 2023
FierceHealthIT
DECEMBER 21, 2023
The biggest stories in 2023, determined by you, the reader, include major hospital mergers, changes to the Medicare Advantage program, Amazon's latest healthcare move, and of course, generative AI. . | Physician pay and workforce issues were top of mind for Fierce Healthcare readers in 2023.
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Medicare Is Cutting 2022 FFS Payments 9.75% & Raising CCM Reimbursements by 54%
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Most healthcare systems & medical practices aren’t prepared for Medicare’s changing priorities. Bonus: Get the Free 5-Day CCM Mini-Course! This eBook will teach you how to: Increase patient engagement. Combat provider burnout. Get reimbursed for staff time.
Exploring Medicare Mental Health Coverage: What’s Covered and What’s Not
DrKumo Remote Patient Monitoring
NOVEMBER 2, 2023
Medicare program, the federally administered health insurance program catering to individuals 65 and above, not only recognizes this holistic approach but extends its coverage to encompass mental health services alongside the modern innovation of remote patient monitoring (RPM).
How the Centers for Medicare Services Supports and Regulates Remote Patient Monitoring Services
DrKumo Remote Patient Monitoring
APRIL 11, 2024
In this digital age, where technology is advancing at an unprecedented pace, the Centers for Medicare Services (CMS) plays a crucial role in regulating and supporting RPM services. The post How the Centers for Medicare Services Supports and Regulates Remote Patient Monitoring Services appeared first on DrKumo.
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Health insurers' profits topped $35B last year. Medicare Advantage is the common thread
FierceHealthIT
FEBRUARY 21, 2020
billion in profit over the course of the year. Big-name health insurers raked in $35.7 Check out the comparisons of how they performed.
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Maximizing Medicare Reimbursement for Remote Patient Monitoring Services: A Guide for Healthcare Providers
DrKumo Remote Patient Monitoring
JANUARY 18, 2023
Medicare-approved Remote Patient Monitoring (RPM) has become an increasingly important aspect of healthcare delivery. Remote monitoring through telehealth services has enabled healthcare providers to provide more efficient and effective care to patients, especially those enrolled in Medicare and Medicaid Services.
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$10B for a primary care provider
David Chou
JANUARY 10, 2023
Oak Street Health is a network of primary care clinics that serve older adults on Medicare. Oak Street Health's expertise in serving older adults on Medicare would be an asset to CVS Health, which has been working on expanding its offerings for this demographic. Pharmacy business growth and Medicare Advantage.
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Thinking About Telehealth Through the Lens of Real Estate – Listening to JLL
Health Populi
MARCH 9, 2022
Of course, it’s of major interest to JLL how and whether telehealth and virtual care could replace demand for brick-and-mortar office space. For those of you focused on serving Medicare or older patients, there are some important findings in the JLL study to add into your scenario planning assumptions. ” she added.
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Everly Health Launches Comprehensive At-Home Collection Kidney Health Test to Address Chronic Kidney Disease
Digital Health Global
OCTOBER 5, 2023
We have an opportunity to significantly change the course of chronic kidney disease in the United States by working to ensure early detection is available to people through the testing they need to protect their kidney health.” Early detection of kidney disease may reduce Medicare costs associated with CKD by 74% or $63.2
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Avoiding Red Flags: Finding the Right Productivity Balance
Healthcare IT Today
NOVEMBER 22, 2022
The number of Medicare TPEs and commercial payer take-back audits alone is skyrocketing. They also look to flag “items and services that have high national error rates and are a financial risk to Medicare.” Meanwhile, Medicare also has a Fee for Service Recovery Audit Program. Tricare and Medicare).
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Zealous for Wellness: Deciding What Kind of Change You Want
Healthcare IT Today
NOVEMBER 15, 2023
The technique involves finding data from public sources such as Centers for Medicare & Medicaid Services (CMS). Data shows that in-home care leads to a shorter course of treatment, lower utilization of the health care system, and better medication adherence. offering in-home treatment.
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Trust My Doctor and Fear the Office: The Telehealth Opportunity in and Beyond the COVID-19 Pandemic
Health Populi
MAY 21, 2020
Among those covered with insurance, one-half had employer-sponsored insurance, 1 in 4 Medicare, and 13%, individual cover. Why it’s telehealth, of course, which has experienced hockey-stick growth in the U.S. Nearly every respondent in the study reported having health insurance coverage.
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Healthcare 2030: Are We Consumers, CEOs, Health Citizens, or Castaways? 4 Scenarios On the Future of Health Care and Who We Are – Part 2
Health Populi
APRIL 16, 2024
A caveat : I do this exercise with clients over the course of an intense immersive weekend or over many weeks (convening weekly or biweekly meetings). Presidential elections to that point, and that the last retiring Baby Boomer enrolls in Medicare that year. In 2030, every Boomer will have been eligible for Medicare.
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PursueCare Completes Series B Fundraising Round and Acquires Digital Therapeutics Developed by Pear Therapeutics, Inc.
Healthcare IT Today
JANUARY 5, 2024
Each product includes a 12-week course of therapy, in which patients are incentivized to complete lessons, adhere to treatment, and abstain from drug use. With this financing, we are charting a course to clinical and commercial scale.”
Medicare Opens the Door to Reimbursement for Remote Patient Monitoring
Digital Health Today
APRIL 25, 2019
When CMS unveiled the first standalone reimbursement for Remote Patient Monitoring (“RPM”) by “unbundling” CPT Code 99091 in the 2018 Medicare Physician Fee Schedule , it opened the door to the widespread use of RPM services for patients and promised there was more to come. Meet our Premier Partners. Want to Partner with Us? Find Out How!
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Aledade Secures $260 Million Series F Financing Round to Expand and Enhance Services for its Nationwide Network of Primary Care Practices
Healthcare IT Today
JULY 10, 2023
Company Adds Two Board Members and a Senior Executive to Lead its Medicare Advantage Business Aledade , the largest network of independent primary care practices in the country, today announced the closing of a $260 million Series F funding round to enhance and acquire services and technology to support its practices.
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Preventing Genetic Testing Fraud: 5 Actions for Health Plans
Healthcare IT Today
MAY 5, 2023
The following is a guest article by Erin Rutzler, Vice President of Fraud, Waste, and Abuse at Cotiviti In Delaware, more than 250 Medicare patients underwent unnecessary genetic testing based on telehealth consultations that often lasted less than two minutes— costing Medicare thousands of dollars per patient. An unlisted code.
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Study of 40.7M adults finds telehealth comparable for chronic conditions
Healthcare IT News - Telehealth
APRIL 29, 2022
Many previous large studies of telehealth use have relied on Medicare data. Although that is helpful for determining utilization among the Medicare population, of course, some behavioral economists have also emphasized the importance of looking to commercially insured groups for a more complete picture. THE LARGER TREND.
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OIG looking closely at telehealth as it weighs future enforcement
Healthcare IT News - Telehealth
AUGUST 11, 2021
They're not submitting a telehealth claim to Medicare. Instead, sophisticated criminal organizations are partnering with telemarketing companies and sometimes unscrupulous doctors to essentially cold call Medicare beneficiaries, get them online with a doctor.
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Where telemedicine is headed now that the PHE has ended
Healthcare IT News - Telehealth
MAY 30, 2023
Some of those expansive measures, like expanded Medicare reimbursement for telehealth, will remain, at least temporarily, and others, like continuous Medicaid enrollment, will be phased out entirely in the next few months. What does the end of the PHE mean for the future of telemedicine?
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For care delivery and older adults, is the time now for AI in Healthcare?
Aging in Place Technology Watch
SEPTEMBER 13, 2023
The Gartner hype cycle on AI is now published – and predicts, of course, a future plateau in generative AI. Several renewals of funding and reimbursement have occurred, the latest extending Medicare reimbursement through 2024 (and no doubt, to be renewed again after that).
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Telehealth has staying power, should benefit from lasting regulatory changes
Healthcare IT News - Telehealth
MAY 6, 2020
Led by researchers from the NYU Grossman School of Medicine, the study found that 2,656 unique providers conducted 144,940 video visits with 115,789 unique patients over the course of six weeks. "Medicare announced its coverage at noon, and we saw our first [Medicare] patient at 5 that day."
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195 Five Offerings from the RockHealth Aging in Place Report
Aging in Place Technology Watch
SEPTEMBER 10, 2020
In their September, 2020 Aging in Place report, the authors note that demographics, regulatory and policy changes (aka reimbursement via Medicare Advantage plans), and Covid-19’s boosted use of digital health combine to make this a pivotal point.
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AMA & other med groups express 'dismay' at prospect of waivers made permanent
Healthcare IT News - Telehealth
JULY 28, 2020
More than 100 physician groups, led by the American Medical Association, told the Centers for Medicare and Medicaid Services in no uncertain terms this past week that, while they supported temporary regulatory relaxations in response to COVID-19, they were strongly opposed to certain rules changes being made permanent. WHY IT MATTERS.
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Closing the Digital Health Gap Between Consumers and Physicians
Health Populi
JULY 20, 2018
Wearable tech is an important category these days in department stores, with discount retailers like Target and Walmart, at electronics outlets like Best Buy and, of course, via Amazon’s wearable tech ma. We have reached a tipping point now that Medicare begins to pay for some virtual care services. ” you ask.
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Telehealth Policy 2018: Keeping You In The Know
South Central Telehealth Resource Center
MARCH 6, 2018
Medicare and Remote Patient Monitoring (RPM) Reimbursement. Effective January 1, 2018, Medicare began reimbursing providers for RPM services billed under CPT code 99091. The Medicare website explains that the change was made to reduce the administrative burden for practitioners. Go to the Medicare Telehealth Services section.
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Here's how smaller practices can prepare for continuing telehealth demands
Healthcare IT News - Telehealth
JUNE 29, 2020
Until regulatory changes, such as those enacted by the Centers for Medicare and Medicaid Services, had made telehealth provision more financially feasible, a doctor "had every economic incentive to require the patient to come to the office in person," he explained.
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Telehealth Law: Healthcare Translation Services for Limited English Proficient People (Case Study)
Telebehavioral Health Institute
JULY 11, 2023
This article also serves as a case study for PART-I of our article series, which identifies and explains the leading federal and state laws requiring healthcare language services for practitioners who serve Medicare and Medicaid beneficiaries or those who work in federally funded settings.
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Adverse Determination Appeals Impact Patient Care
BHM Healthcare Solutions
MAY 17, 2023
Adverse determination appeals can have a significant impact on patient care, as it can potentially change the course of treatment and improve patient outcomes. Consulting with healthcare professionals and legal experts can provide more tailored information and guidance for specific cases.
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Aspects of Social Determinants of Health: Specific Types of Help
Healthcare IT Today
OCTOBER 20, 2023
Of course, selecting patients along any sort of criteria is controversial.) Another source of fresh foods for low-income people is FarmboxRx , often available through Medicaid and Medicare Advantage programs as part of SNAP or Healthy Food Card benefits.
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Why Electronic Health Record Interoperability is a Key Step Toward Fair Drug Prices
Healthcare IT Today
OCTOBER 10, 2022
With recent legislation allowing Medicare to negotiate prices, it’s likely that the movement will grow , given the high and constantly rising costs of pharmaceuticals, especially gene therapies and other innovative or personalized drugs.
Rethinking Medication and Information Technology
Healthcare IT Today
APRIL 6, 2023
” Of course, our reimbursement system doesn’t allow time for such conversations. Another article recommended by Rose points out that medication adherence for some of the most important and effective medicines (statins, hypertension, diabetes) directly determine about 9% of the Star Ratings for Medicare Advantage health plans.
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Telehealth and the CHRONIC Act of 2017 (S. 870)
South Central Telehealth Resource Center
OCTOBER 24, 2017
House of Representatives, allows for an expansion of telehealth/telemedicine coverage under the Medicare Advantage Plan B. Medicare Advantage Plan B is an optional insurance that covers medically necessary and preventative healthcare services, supplies, and select prescription medications for individuals 65 and older.
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Can Digital Technologies Help Overcome Diabetes? An Assessment of the Recent PHTI Review
Healthcare IT Today
APRIL 8, 2024
So do doctors and patients, before they go through the trouble of adopting a course of treatment. ” PHTI justified the exclusion because this expensive form of monitoring isn’t yet covered by many payers (and notably not by Medicaid and Medicare).
Hearing aid pricing and weak insurance – older adults lose out
Aging in Place Technology Watch
APRIL 10, 2019
Which of course has led to the effort to sell hearing aids directly to consumer (remember that commercial?) What is really worrisome is that hearing aids, which correct a condition that can cause substantial health issues, including fall risks and dementia, which are costs to Medicare, are considered an ‘elective’ device. Seriously?
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White House Office on National Drug Policy: Telehealth Prescribing for Substance Use Disorders
Telebehavioral Health Institute
JULY 21, 2022
During the Public Health Emergency (PHE), the Centers for Medicare and Medicaid Services (CMS) expanded reimbursement for telehealth access as a temporary measure. See below TBHI’s previous articles on the updates of Medicare laws related to telehealth prescribing. Telehealth Prescribing Expansion.
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Why Implementing Telehealth Is Worth the Cost
AMD Telemedicine
JANUARY 6, 2022
Healthcare organizations around the world are faced with a lot of uncertainty right now and have to make pretty major decisions about their course of action to survive in the new hybrid model of healthcare delivery. Why the Benefits Outweigh the Initial Cost of Implementing Telehealth. Telehealth reimbursement is now possible.
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Telehealth and Program Integrity
Connected Health Initiative
FEBRUARY 8, 2021
Millions of Americans turned to live audio and video visits with healthcare providers during the COVID-19 pandemic, and Congress needs to make decisions that will permanently affect how Americans, in particular Medicare patients, may access these telehealth services on a permanent basis. Postal Service—to detect these schemes and stop them.
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Conifer Health Solutions Security Incident Impacts Patients at 5 Healthcare Organizations
Healthcare IT Today
AUGUST 17, 2022
Like most investigations, they weren’t able to tell conclusively if personal information was accessed or not and of course they don’t know of any misuse of the data. Please note that not all data elements were involved for all individuals.
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Can you identify 7 qualities of a successful telehealth program?
South Central Telehealth Resource Center
AUGUST 8, 2018
New legislation at state and federal levels is making it possible for telehealth services to be reimbursed by Medicare, Medicaid and private insurance carriers. In addition to self-pay patients, reimbursement can be sought through Medicaid, Medicare and commercial/private payers. Reimbursement is also key to telehealth program growth.
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When is E-prescribing Mandatory for Psychiatrists?
TheraNest
NOVEMBER 23, 2020
The American Psychiatric Association has historically petitioned the Centers for Medicare and Medicaid Services to relax certain requirements around e-prescribing due to various challenges around its use. Of course, e-prescribing is not without its flaws and limitations. But not every provider finds e-prescribing attractive.
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