Thinking About Health Care One Year From the 2020 Presidential Election

Health Populi

Americans are roughly split — and/or equally confused — about the differences between three major health reform approaches: Medicare -for-All, improving the existing Affordable Care Act, or replacing the ACA with state-run health plans.

Why It's Time to Embrace Telemedicine


What’s this new thing called Telemedicine? For starters, it’s not new! I t’s more than 40 years old and was developed as a way to use improvements in communication technology to bring quality medical diagnoses and care to individuals in remote parts of the world.

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

Electronic Health Reporter

The article How Skilled Nursing Facilities Need To Prepare For Value-Based Care appeared first on Editorial long-term care Medicare fee-for-service skilled nursingThis article is copyrighted strictly for Electronic Health Reporter.

CMS plans to release list of 400 troubled nursing homes following Senate report


The Centers for Medicare & Medicaid Services announced a plan to release the names of the 400 lowest-performing nursing homes

What Is the Patient Driven Payment Model: How Skilled Nursing Providers Can Get Ahead of PDPM

Electronic Health Reporter

The Patient Driven Payment Model (PDPM) is more than just a new name attached to Medicare payment reform. The shift from Resource Utilization Group (RUG) IV to PDPM moves the skilled nursing reimbursement model away from therapy provision as its main driver.

Telemedicine improves care, keeps patients in place at skilled nursing facility

Healthcare IT News - Telehealth

The skilled nursing sector has undergone a major transition over the past ten years. Because of shifting demographics and the challenges they place on hospitals, skilled nursing facilities are receiving patients who are struggling with more significant health concerns than in the past.

Payer Roundup—Trump rails against Medicare-for-all; Medicare paying nursing facilities more for rehabilitation


The president attacked a Medicare-for-all proposal in an opinion column on Wednesday, and the senator who introduced that bill hit back. Plus, a study suggests for-profit nursing homes are sending patients to therapy at the end of their lives to make more money

Florida healthcare executive convicted in $1.3B Medicare, Medicaid fraud scheme 


The owner of several South Florida skilled nursing and assisted living facilities has been found guilty for his role in a $1.3 billion scheme to defraud Medicare and Medicaid—one of the largest in U.S. history.

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.

Medicare Reimbursement for Remote Monitoring Should Drive Adoption (What a long, strange trip it’s been….)

The cHealth Blog

The Centers for Medicare & Medicaid Services (CMS) released the 2018 Physician Fee Schedule about two weeks ago and there is at least one nugget in there that should speed the adoption of remote patient monitoring.

CMS conducting 'comprehensive review' of nursing home oversight processes following OIG report


The Centers for Medicare and Medicaid Services is undertaking a comprehensive review of its regulations and processes when it comes to ensuring safety and quality in nursing homes, CMS Administrator Seema Verma announced Monday. On the same day, HHS' Office of Inspector General released a report saying CMS needs to do more to address gaps in federal oversight of nursing home investigations in Oregon

CMS guidance aims to ease access to nursing home waivers for ACOs


The Centers for Medicare & Medicaid Services is making it easier for accountable care organizations that accept downside risk to obtain waivers for a rule that requires a three-day inpatient stay before a referral to a nursing home

What $285,000 Can Buy You in America: Medical Costs for Retirees in 2019

Health Populi

That retirement cost gap is the sticker-shock assumption that Medicare is going to cover all health care expenses in retirement.

More Evidence of Self-Rationing as Patients Morph into Healthcare Payors

Health Populi

Wolters Kluwer released a summary of a study this week, to be published in full in 2020, surveying 1,000 consumers (232 of whom had been a hospital inpatient in the past year) and 837 health care providers (a mix of physicians, nurses, and hospital administrators).

The Promise of Telehealth for Older People – the U-M National Poll on Healthy Aging

Health Populi

Health Populi’s Hot Points: I recently collaborated with HealthMine on a survey looking into Medicare Advantage members’ views of health and digital technology. But remember that the trusted relationship — for “now” — remains between the patient and the doctor, nurse and pharmacist.

AHIMA and AHCA Partner To Train Skilled Nursing Facilities In Coding Ahead of Upcoming Reimbursement Overhaul

Electronic Health Reporter

1, 2019, the Centers for Medicare […]. The article AHIMA and AHCA Partner To Train Skilled Nursing Facilities In Coding Ahead of Upcoming Reimbursement Overhaul appeared first on This article is copyrighted strictly for Electronic Health Reporter.

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

The interoperability 'Golden Spike'

Morning eHealth

Modest Medicare telemedicine increase — Yelp 'beats' CMS at nursing home rating

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.

Ensuring Safety and Quality in America’s Nursing Homes

Ensuring Safety and Quality in America’s Nursing Homes. Administrator, Centers for Medicare & Medicaid Services. Nursing facilities. While we support and promote the private sector’s critical role in our health care system, CMS’ duty to monitor the safety of the nation’s hospitals, nursing homes, and other providers, is a unique governmental task which lies at the core of government’s role in health care. We’re also improving quality of life for nursing home residents.

Health Is Social – The Social Determinants of Health at HIMSS19

Health Populi

Patients most-trust their clinicians, physicians and nurses, as safe places in which to have an honest SDoH discussion, compared with a health insurance representative. To mitigate SDoH risks for older Americans, Medicare has begun to pay for services that promote coordinated care.

HEART Act Targets Medicare Limits on Telehealth

American Well

the Helping Expand Access to Rural Telehealth (HEART) Act targets the Center for Medicare & Medicaid Services’ (CMS) strict limitations on RPM reimbursements in rural areas. Of the 107,000 telemedicine visits for Medicare beneficiaries recorded in 2013, approximately 40,000 of them served rural areas. As of 2012, the average cost of a telehealth program was $1,600 per patient each year , versus $13,000 for home health services and $70,000 for nursing home care.

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.

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.

CMMI director: Home visits could be focus of upcoming Medicare demos


To fill the physician gap, nurses and other medical professionals could join in this effort As founder of Landmark Health, Adam Boehler sees home visits as one way to move from volume to value.

Combating Opioid Overprescription

BHM Healthcare Solutions

Editor’s Note: Increasing costs for prescriptions is creating a long-term financial impact on Medicare Part D and its beneficiaries. Soon after the investigation spread to the Appalachian region, dozens of physicians, nurses, pharmacists and more were indicted for their alleged connections to 350,000 illegal prescriptions. Increasing costs for prescriptions is creating a long-term financial impact on Medicare Part D and its beneficiaries.

CPT Billing Codes reimburse for Care Coordination (Medicare)

Medicine and Technology

Let's face it: physicians spend a lot of time coordinating care for their older adult patients, especially when patients leave hospitals or nursing homes. Medicare is now accepting newly created Current Procedural Terminology (CPT) codes for care coordination to pay physicians for the management of patients who have recently been discharged from a hospital or skilled nursing facility. AMA billing CPT Medicare

2018 Medicare Fee-For-Service improper payment rate is lowest since 2010

2018 Medicare Fee-For-Service improper payment rate is lowest since 2010. Administrator, Centers for Medicare & Medicaid Services. 2018 Medicare Fee-For-Service improper payment rate is lowest since 2010 Significant progress in saving $4.59B in estimated improper payments for the Medicare Fee-For-Service program. Most notably: The 2018 Medicare-FFS improper payment rate decreased from 9.51 Skilled nursing facility corrective actions resulted in a $1.04


Payer, provider trends to watch in 2019

Henry Kotula

At Riverside Health System, a rural health network in Newport News, Virginia, a long-term telebehavioral health initiative has improved coordinated care among psychiatrists and clinical social workers, as well as replaced a chunk of services offered at the system’s nursing homes.

Healthcare Roundup—ProMedica finalizes purchase of HCR ManorCare


ProMedica Health System and HCR ManorCare have finalized their merger, Medicare has dinged nursing homes for staffing issues, plus more healthcare headlines

SBIRT - Coding for SBI Reimbursement

Medicine and Technology

Most doctors and nurses don't know this, but reimbursement for screening and brief intervention is available through commercial insurance CPT codes, Medicare G codes, and Medicaid HCPCS codes. The Substance Abuse & Mental Health Services Administration or SAMHSA is working with the Centers for Medicare and Medicaid Services (CMS) to educate practitioners about the importance of SBIRT coverage and the Medicare billing rules around these services.

Telehealth Research Used to Support New Policy Initiatives for Expansion

care innovations

Telehealth Research Points to Benefits for Skilled Nursing Facilities. The CMS is also offering more support for expanding the use of telehealth in the nation’s skilled nursing facilities (SNFs).

Telehealth Policy 2018: Keeping You In The Know

South Central Telehealth Resource Center

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.

While Costs Are A Top Concern Among Most U.S. Patients, So Are Challenges of Poverty, Food, and Housing

Health Populi

Humana also launched a “Bold Goal” initiative to boost healthy food access for people enrolled in the plan’s Medicare Advantage programs. These are social determinants of health that lie well beyond the prescription pads of doctors, nurses, pharmacists and disease managers.

Having Health Insurance Is A Social Determinant of Health

Health Populi

Medicare enrollees, too, would face higher payments. For some of us who went to school in public health, nursing, medicine, social work, education, it is obvious and even cliché that having health insurance bolsters health.

What We Know We Know About ZIP Codes, Food, and Deaths of Despair – HealthConsuming Explains, Part 3

Health Populi

The growth of public sector incentives in Medicare for social supports, and growth of value-based payment in commercial plans, are forces nudging health care providers toward bundling SDoH services into targeted programs.

CMS rule dump: Post-acute providers get a pay bump, plus a new value-based payment arrangement


In a late-Friday rule dump, the Medicare agency proposed boosts to its annual payments for post-acute providers, including skilled nursing facilities and hospice. The proposals also included policy changes like reduced reporting measures, and even a new value-based payment arrangement

How the media loves to talk about loneliness among older adults

Aging in Place Technology Watch

Did you know that ‘social isolation’ has become a named baby boomer health condition spiking Medicare costs by an additional $134 per enrollee – tucked into the list that includes arthritis (+$117 of cost) and diabetes (+$270), source AARP? Shall we take this WSJ article at face value?

With the Silver Tsunami on its way, telehealth is ready for its moment

Healthcare IT News - Telehealth

Whether deployed as an affordable means of after-hours medical coverage at skilled nursing facilities, or as intuitive voice activated home tools to help with remote monitoring and distance-based consults, telehealth is reaching maturation at just the moment it's needed most.

eCare 169

Reimbursement Update: It’s raining new codes!

The cHealth Blog

In that post, I had referenced the Lemony Snicket movie, “A Series of Unfortunate Events,” noting that Medicare reimbursement for remote monitoring was just the opposite: it was the culmination of a series of fortunate events.