z-PAX, Post-Acute eXchange的动态

Medicare's PDPM structure is consistent nationally, but across the 30+ state Medicaid systems that adjust reimbursement using the MDS, all bets are off. To manage PDPM-based CMI, state-specific expertise is essential. Beyond the PDPM score, depending on the state, Medicaid Rate Construction is a nuanced equation that involves cost reporting, wage-indexing, Direct Care cost allocations driven by population acuity differentials, eligibility markers, add-ons, offsets, and an endless array of arbitrary adjustments. Those delicate variables are carefully poured into a chaos-blender to be transmuted into a pasty bolus of distortion and mispricing that threatens the financial integrity of the entire long-term care sector, but that's not the point. What matters today is that CMI-Connect & PDPM-Connect are gamechangers in clinical reimbursement management and efficiency. Ask any one of the 1,200+ SNFs already using Connect to enhance Reimbursement-compliance and reduce MDS administration time by up to 50%. The SNF-Economy is changing quickly. "Get Connected" today.

The Centers for Medicare and Medicaid Services (CMS) has approved a substantial increase in the reimbursement rate for Aquadex SmartFlow? Therapy, effective January 1, 2025. The rate will surge by 397%, from $413 to $1,639 per day. This development significantly enhances patient access to the life-saving ultrafiltration therapy, particularly in outpatient settings. Nestor Jaramillo, President and CEO, expressed, “This adjustment underscores the clinical significance and cost-effectiveness of our technology, leading to enhanced patient outcomes and reduced hospitalizations.” Special thanks to our clinical partners, Dr. Maria DeVita and Dr. Jennifer Cowger, for their invaluable support throughout this process. This achievement not only benefits providers financially but also highlights Aquadex's proven efficacy in managing fluid overload. Our commitment to revolutionizing patient care through innovation and collaboration remains unwavering. For further details on this update and our initiatives in fluid management, please visit www.nuwellis.com. #Nuwellis #FluidManagement #AquadexSmartFlow #HealthcareInnovation #CMS #Medicare #PatientCare #OutpatientTherapy

The Centers for Medicare & Medicaid Services have proposed the inclusion of 3 digital #mentalhealth treatment codes to be included in the Medicare Physician Fee Schedule, the first time DTx products have ever been considered for reimbursement by Medicare. In a recent interview with Healthcare IT News, Digital Therapeutics Alliance CEO Andy Molnar talks about the impact this can have for the #DTx industry. Read the full article: https://lnkd.in/drT3yc95 #digitaltherapeutics #digitalhealth #medicarereimbursement

HOT OFF THE PRESS! Read our comments to #CMS, the Centers for Medicare & Medicaid Services on the Medication Prescription Payment Plan (#MPPP). The #inflationreductionact #ira will bring about far-reaching changes for #Medicare patients and the broader #raredisease patient community. For some of these changes, the actual patient impact - and the effects on #drugdevelopment - remain to be seen. One program that will unequivocally benefit many #raredisease patients and that has a long history of strong bipartisan support is the Part D redesign, which among other things limits patients' annual out-of-pocket costs to $2,000 and allows patients to spread out these costs over the plan year through 'smoothing.' As with many things in #healthpolicy, though, the devil will be in the details and successful implementation will hinge effective patient engagement and education. The National Organization for Rare Disorders is proud to provide comments to #CMS on how best to engage patients and healthcare providers to ensure success of the program and maximize its positive impacts on patients - after all, we know that out-of-pocket costs are one big factor in medication adherence and ultimately health outcomes.

CMS Increases Reimbursement for Complex Care Delivery: Integrate G2211 into Your Practice Webinar? Monday, January 29? 4:00 PM ET At the start of this year, the Centers for Medicare and Medicaid Services (CMS) finalized the implementation of G2211, an add-on code that can be used by endocrinologists to pay for complex care services delivered by a provider with an ongoing relationship with the patient. Endocrinologists are eligible to bill using this code for some of their patients: https://bit.ly/3u1yMB8 Learning Objectives? ? Determine eligibility to bill for this code at your practice.? ? Implement the new G2211 add-on code which will increase reimbursement for complex care.? ? Understand what the Endocrine Society is doing to advocate for adequate physician reimbursement.??

What are your thought on the CMS Proposed Bundled Payment Model for 2026? Do hospitals nead more accountability or perhaps payers need some accountability? “The Center for Medicare and Medicaid Innovation (CMMI) has proposed a new, mandatory episode-based payment model for hospitals in certain geographic areas starting in 2026. This model is called the Transforming Episode Accountability Model (TEAM) and will test an approach where hospitals receive a target price to cover all costs associated with the episode of care. This includes the cost of the hospital inpatient stay or outpatient procedure, as well as items and services following hospital discharge. The model will last for five years.”

The U.S. Center for Medicare and Medicaid Innovation is launching a new Quality Pathway to elevate patient-centered quality goals in the design and evaluation of alternative payment models. The Quality Pathway will align model design around quality goals; elevate outcomes and experience measures, particularly patient-reported outcomes; and ensure that evaluations have the ability to assess the impact of models on primary quality goals. These determinations will help the Innovation Center make critical decisions about which models to scale or expand in the pursuit of improving the quality of care for people with Medicare and Medicaid: https://nej.md/3xoXUmU

LinkedIn Live: Recent CMS Managed Care Final Rule HMA's LinkedIn live details some items from the?managed care final rule?that the?Centers for Medicare & Medicaid Services (CMS) filed for publication on April 22, 2024. Policy changes fall into the following major categories: in lieu of services and settings, the Medicaid and CHIP Quality Rating System, medical loss ratios, network adequacy, and state directed payments. These revised policies will affect Medicaid coverage and reimbursement for years to come. HMA experts will highlight their initial takeaways and insights for organizations affected by the new rules. Kathleen Nolan Joe Moser Michael Engelhard David Nater Jesse Eller

MIPS Value Pathways (MVPs) are the newest reporting option to fulfill MIPS reporting requirements under the Quality Payment Program (QPP). As MVPs become mandatory, who is eligible to report? - Individual clinicians - Single specialty groups - Multi-specialty groups - Subgroups - APM Entities The Centers for Medicare & Medicaid (CMS) finalized other MVP policy updates in the most recent Physician Fee Schedule Final Rule. Health Catalyst’s Shakeel Khan, Senior Director, Product Management of Measures & Registries, sheds light on what to expect and how to participate in the MIPS Value Pathways in Performance Year 2024 and beyond: https://ow.ly/WkQg50QZWSp

On behalf of the non-hospital, community-based infusion providers we represent across the country and the patients they provide care for, NICA commends the U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services for deciding not to move forward with the proposal to “stack” drug discounts in the Medicaid Drug Rebate Program (MDRP). We sincerely appreciate HHS and CMS for heeding the calls from NICA and our provider members, members of Congress, patient, provider, and health equity advocates, and others on the harms this rule would pose to patients and those who care for them – especially in America’s infusion centers. #infusionprovider #medicalprovider #infusion #infusioncenter #infusionnurse #infusiondeliverychannel #medicalinfusionprovider #futureofhealthcare