Telehealth Payments Don’t Meet Medicare Requirements

BHM Healthcare Solutions

Payers are rapidly becoming educated in telehealth and are keen on closing telehealth gap, but need to be mindful of Medicare requirements. Almost a third of telemedicine claims sampled by HHS’ Office of Inspector General did not meet Medicare requirements, resulting in an estimated $3.7

Industry Voices—Attention Medicare Advantage plans: It’s not too late to meet year-end goals

FierceHealthIT

Medicare Advantage plans still have time to meet their year-end goals

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Talk to Me About My Health, Medicare Advantage Beneficiaries Tell J.D. Power

Health Populi

Cost is the major reason why Medicare Advantage plan beneficiaries switch plans, but people who switch also tend to have lower satisfaction scores based on non-cost factors. Power’s 2019 Medicare Advantage Plan Study.

Tweets at Lunch with Paul Krugman – Health IT Meets Economics

Health Populi

I greatly appreciated the opportunity today to attend a luncheon at the HX360 meeting which convened as part of the 2018 HIMSS Conference. The post Tweets at Lunch with Paul Krugman – Health IT Meets Economics appeared first on HealthPopuli.com.

Medicare: Cover CGMs Now!

Insulin Nation

Unfortunately, Medicare policy hasn’t kept up with evolving diabetes technology, and policymakers have left out CGMs from the list of reimbursable diabetes devices. There have been several petitions circulating to pressure lawmakers to make Medicare cover CGMs.

Medicare Opens the Door to Reimbursement for Remote Patient Monitoring

Digital Health Today

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.

When Will Self-Service Come to Health Care?

Health Populi

A common theme at health care meetings these days is how and when health care will meet its Amazon, Apple, or Uber moment?

Patients Growing Health Consumer Muscles Expect Digital Services

Health Populi

Do not assume that older people, and especially “younger older” Medicare members between 65 and 74 don’t increasingly feel this way.

The New Drug Companies Aren’t Drug Companies At All

Health Populi

This research organization will develop medicines targeting older adults — which makes sense because Clover Health’s target consumer market is Medicare Advantage beneficiaries.

Medicare Told to Cover CGMs in Ruling

Insulin Nation

Medicare doesn’t typically provide coverage for continuous glucose monitors (CGMs), as insurors who oversee Medicare coverage have long argued that CGMs are a “precautionary” device rather than a “medically necessary” one. The Medicare-insuring contractor denied the claim.

National Health Spending Will Reach Nearly 20% of U.S. GDP By 2027

Health Populi

every year from 2020 to 2027, the actuaries at the Centers for Medicare and Medicaid Services forecast in their report, National Health Expenditure Projections, 2018-2927: Economic And Demographic Trends Drive Spending And Enrollment Growth , published yesterday by Health Affairs.

Do Medicare providers located at a Distant Site have to be hospital-based to provide services?

South Central Telehealth Resource Center

Q: Per Medicare regulations, do the providers at a distant site have to be hospital-based or can they be in a private setting – for example, a group of pulmonologists who want to create a telehealth system on their own? Also, all telehealth services must meet the Medicare established set of criteria for reimbursement. Click here to visit the Medicare Eligibility Analyzer site. To review CCHP information on Medicare, go to: [link]. Medicare

MedPAC debates what form a Medicare without fee-for-service payment might take

FierceHealthIT

MedPAC plans to focus heavily on value-based payment in the coming months, and at its meeting Thursday the commissioners weighed what a Medicare without fee-for-service might look like.

Health/Care Everywhere – Re-Imagining Healthcare at ATA 2019

Health Populi

“ATA” is the new three-letter acronym for the American Telemedicine Association, meeting today through Tuesday at the Convention Center in New Orleans.

Health Care and the Democratic Debates – Part 1 – Medicare For All, Rx Prices, Guns and Mental Health

Health Populi

Elizabeth Warren assertively and transparently backed Bernie Sander’s Medicare for All proposal. Let’s take on pharma, allow negotiations of prices under Medicare.

Talking “HealthConsuming” on the MM&M Podcast

Health Populi

We’d been trying to schedule meeting up to do a live podcast since February, and we finally got our mutual acts together on 6th August 2019. Marc Iskowitz, Executive Editor of MM&M, warmly welcomed me to the Haymarket Media soundproof studio in New York City yesterday.

Health Insurer Growth Plans Held Back By Tech And Infrastructure Limitations

Healthcare IT Today

Health plans are eager to grow their Medicare business but may not be able to meet their goals unless they build out their tech and administrative infrastructure further, according to results from a survey backed by health plan technology vendor HealthEdge.

CMS’ Rural Health Strategy Could Expand Medicare Telehealth Reimbursement

care innovations

Congress and the Centers for Medicare & Medicaid Services (CMS) have generated hope among health plans, insurers, providers and patients that Medicare telehealth reimbursement is set to expand significantly in the year ahead. A series of moves in recent months by the U.S.

How Skilled Nursing Facilities Need To Prepare For Value-Based Care

Electronic Health Reporter

The resources required to meet the care needs of […]. Editorial long-term care Medicare fee-for-service skilled nursingThis article is copyrighted strictly for Electronic Health Reporter. Illegal copying is prohibited.

Prescription drug costs, Medicare for All debate take center stage as Pelosi, McConnell address hospitals

FierceHealthIT

Hospital leaders were treated to opposing healthcare arguments from the nation's top congressional leaders headed to the AHA's annual meeting Tuesday

Changes to Medicare Advantage Plans Could Allow for Expansion of RPM Services in Senior Care

care innovations

And that means that “senior living companies that double as Medicare Advantage insurers” will be given the opportunity for reimbursement for new modes of care targeting patient with chronic conditions. Changes to Medicare Advantage Plans Designed to Reduce Rehospitalizations.

Heart Health at #CES2019 – Food and Tech as Medicine

Health Populi

An important example of this self-care approach is the evidence-based Ornish food regimen which is reimbursed by Medicare (as a form of cardiac rehabilitation). Self-care is the new health care as patients, now consumers at greater financial risk for medical spending, are learning.

Telehealth Assistance Resource Pages

South Central Telehealth Resource Center

Other Telehealth Resource Centers (TRCs) have created similar sites in response to the coronavirus outbreak in order to meet the needs of their clients as well. COVID19 General Medicaid Medicare My TRC Real World Examples Telehealth

How Walmart Could Bolster Healthcare in the Community

Health Populi

Here’s one description about the chain’s plans to use $200 mm to expand in Florida (THINK: the state will be home to 4,5 million people age 65 and over in 2020, potential candidates for Humana’s Medicare programs. Walmart has been a health/care destination for many years.

Heart-Love – Omron’s Holy Grail of Blood Pressure Tracking on the Wrist

Health Populi

” I’m glad to report that we’ll be there before the end of the year, based on my meet-up with Omron Healthcare at #CES2018.

How The Rapid Shift To Telehealth Leaves Many Community Health Centers Behind During The COVID-19 Pandemic

Henry Kotula

For Medicare, the Centers for Medicare and Medicaid Services (CMS) expanded access to telehealth beyond designated rural areas, loosened HIPAA requirements around telehealth platforms, and instituted parity in reimbursement with in-person visits. [link].

CMS’s Price Transparency Initiatives for 2020

BHM Healthcare Solutions

Editor’s Note: Increasing costs for prescriptions is creating a long-term financial impact on Medicare Part D and its beneficiaries. Here are 10 takeaways from the proposed rules: Medicare Outpatient Prospective Payment System. Medicare Physician Fee Schedule.

MACRA: Medicare’s Opportunity to Finally Embrace Connected Health Technology

ConnectedHealth

The nation’s healthcare system is in the middle of a major transition – one that, if done well, will have an incredible impact on the lives of millions Americans who rely on Medicare. For a long time, Medicare has had a reputation for being bureaucratic, lethargic, wasteful, and outdated. Further, the Center for Medicare and Medicaid Services (CMS), which administers Medicare, has been slow to incorporate advances in advanced health technology in the program.

Farzad Mostashari: CMS should look to Medicare Advantage to improve accountable care

FierceHealthIT

To help meet that goal and support accountable care organizations, he should look to Medicare Advantage for inspiration, say Farzad Mostashari, M.D., HHS Secretary Alex Azar has made it clear that the transition to value-based care is one of his priorities. and Travis Broome

AMA says yes to strengthening ACA, no to ending opposition to 'Medicare-for-All' single-payer reform

FierceHealthIT

At its annual meeting in Chicago this week, the American Medical Association’s delegates voted to adopt a new policy that boosts its push for universal coverage by improving the Affordable Care Act

Why People Are Still Avoiding the Doctor (It’s Not the Virus)

Henry Kotula

A pharmacist helped, but Mr. Chapman no longer has insurance, and is not sure what he will do until he is eligible for Medicare later this year. “We’re She said she would dread “a fight with the insurance company if you don’t meet their guidelines.”.

Blockchain in Healthcare: A Vehicle Towards Digital Health 2.0?

The Digital Health Corner

The blockchain rubber meeting Wall Street’s road is already here. digitalhealth clinical trials digital health digital health technology drug addiction FDA healthcare economics Healthcare IT IT security medical apps medical devices patient engagement patient safety pharma technology #hcldr blockchain cybersecurity EHR healthcare IT hospitals Medicare telehealthI would like to apologize to the readers of this site for the long hiatus.

Doctors Without Patients: ‘Our Waiting Rooms Are Like Ghost Towns’

Henry Kotula

Federal officials have taken some steps to help small practices, including advancing Medicare payments and reimbursing doctors for virtual visits. Federal officials used last year’s payments under the Medicare program to determine which groups should get the initial $30 billion in funds.

Texting patient information – The latest from CMS

Health Blawg

We are now back to the status quo ante, at least with respect to the question of whether and how texting may be used in hospitals subject to the Medicare Conditions of Participation (i.e., So, when you’re shopping for your next CPOE tool, remember this: Any smartphone-based tool for CPOE must meet the CMS requirements outlined above as well as all HIPAA requirements. CMS has a communications problem.

HIE 95

Fred Trotter on Data Journalism and Cybersecurity — Harlow on Healthcare

Health Blawg

Fred notes that the DocGraph dataset of Medicare physician relationships with patients is the largest graph dataset — i.e. a dataset organized with nodes and edges — using real-name data out there, and is one of the few “people” graphs that are open. ” And every fear voiced in those meetings was realized over the course of the next year.

Texting patient information – The latest from CMS

Health Blawg

We are now back to the status quo ante, at least with respect to the question of whether and how texting may be used in hospitals subject to the Medicare Conditions of Participation (i.e., CMS has a communications problem.

HIE 78

Texting patient information – The latest from CMS

Health Blawg

We are now back to the status quo ante, at least with respect to the question of whether and how texting may be used in hospitals subject to the Medicare Conditions of Participation (i.e., CMS has a communications problem.

HIE 78

Fred Trotter on Data Journalism and Cybersecurity — Harlow on Healthcare

Health Blawg

Fred notes that the DocGraph dataset of Medicare physician relationships with patients is the largest graph dataset — i.e. a dataset organized with nodes and edges — using real-name data out there, and is one of the few “people” graphs that are open.

Fred Trotter on Data Journalism and Cybersecurity — Harlow on Healthcare

Health Blawg

Fred notes that the DocGraph dataset of Medicare physician relationships with patients is the largest graph dataset — i.e. a dataset organized with nodes and edges — using real-name data out there, and is one of the few “people” graphs that are open.

GAO: CMS must do better job monitoring quality programs, funding

FierceHealthIT

A government watchdog found the Centers for Medicare & Medicaid Services hasn't done a good job of tracking quality program funding or whether quality measures meet goals