Health Care Reform

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CMS Publishes Over 1,000 New ICD-10-CM Codes Effective on October 1, 2022

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Each October 1st, the newest updates to ICD-10-CM take effect. This year with more than a thousand new codes added there is a lot of information to dig into and prepare our providers for. Many of the deleted and changed code descriptions, including the endeavor to capture social determinants of health, were made to enable expansion of specific coding categories so additional details could be reported, when captured in the documentation.

CMS Encourages Medicaid MCOs and CHIP to Employ Section Waivers to Improve SDoH and Reduce Healthcare Costs

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Over the past few years, at least 15 states have consistently pursued the goal of using social determinants of health (SDOH) in their overall healthcare analysis and treatment programs for patients, and CMS has taken notice. Data and outcomes obtained from these state programs have essentially provided an outline of how the government intends to pursue health equity through managed care contracts (MCOs) and Children's Health Insurance Program (CHIP). What is CMS seeing that they like so much and how might that affect future MCO contracts?

How CMS Determines Which Telehealth Services are Risk Adjustable

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Medicare Advantage Organizations (MAOs) have gone back and forth on whether or not to use data collected from telehealth, virtual Care, and telephone (audio-only) encounters with Medicare beneficiaries for risk adjustment reporting, but the following published documents from CMS cleared that up once and for all by providing an answer to a question specifically related to this question.

HHS Leaders Urge States to Maximize Efforts to Support Children’s Mental Health

by  SAMSHA Newsroom

Today, agencies across the U.S. Department of Health and Human Services (HHS) issued a joint letter to states, tribes, and jurisdictions encouraging them to prioritize and maximize their efforts to strengthen children’s mental health and well-being. The letter, signed by leaders of the Health Resources and Services Administration (HRSA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), the Administration for Children and Families (ACF), and the Administration for Community Living (ACL), outlines HHS’ plans to support and facilitate state-level coordination across federal funding streams to advance and expand mental health services for children.

Congress Has Been Busy — 11 Different Bills Pass Covering Mental Health and Substance Use

by  Wyn Staheli, Director of Content - innoviHealth

The House of Representatives has certainly been working hard to advance behavioral health services. This article summarizes each of those bills and includes a link to contact your Senator.

HHS Proposes Significant Changes to Patient Access Rules

by  Wyn Staheli, Director of Content - innoviHealth

In a significant announcement on February 11, 2019, HHS proposed new rules aimed at improving interoperability of electronic health information. This announcement was made in support of the MyHealthEData initiative which was announced by the Trump administration on March 6, 2018. The goal of that initiative was to break down ...

CMS Finalizes Major Changes to ACO Program

by  Wyn Staheli, Director of Content - innoviHealth

Back in August of 2018, as part of the Medicare Shared Savings Program (Shared Savings Program), CMS proposed some sweeping changes for Accountable Care Organizations (ACOs). There has been some controversy over these changes which require ACOs to move to two-sided models. In this Final Rule which was scheduled to be published in the Federal Register ...

WHO Said ICD-11 is Coming Soon

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Sooner or later ICD-11 will be released, and it sounds like it will be sooner than later. WHO released the news on June 18, 2018. The World Health Organization stated “ICD-11 will be presented at the World Health Assembly in May 2019 for adoption by Member States, and will come ...

VA Expands Telehealth

by  Wyn Staheli, Director of Content - innoviHealth

On May 11, 2018, the Department of Veterans Affairs (VA) released its final rule on the "Authority of VA Health Care Providers to Practice Telehealth." Effective June 11, 2018, VA providers will be able to provide telehealth services across state lines. This move will make it easier for veterans to obtain ...

Will Chiropractors Benefit from Medicare's Proposed Reformations?

by  Wyn Staheli, Director of Content - innoviHealth

Recently, Medicare's Innovation Center released an informal Request for Information (RFI) seeking input on several different system reformation proposals. As the market moves towards value based payment systems, new models are being sought to both reduce costs and increase quality. This article outlines some of the ideas presented in the RFI which ...

Understanding The Healthcare Fraud Prevention Partnership's Commitment to the Management of Opioid Misuse and Opioid Use Disorder

by  Jared Staheli, MPP

The opioid epidemic continues to ravage communities nationwide. Since 1999, opioid deaths have quadrupled. 91 Americans die every day from opioid overdoses, and these numbers show no signs of declining. To address an epidemic of this magnitude, unprecedented cooperation between all involved parties needs to occur. In January 2017, CMS released a ...

HIPAA and the Opioid Crisis

by  Wyn Staheli, Director of Content - innoviHealth

HIPAA and the Opioid Crisis guidance released by HHS.

MIPS - To Participate or Not Participate - That is the Question

by  Wyn Staheli, Director of Content - innoviHealth

Medicare’s Merit-based Incentive Payment System (MIPS) Final Rule increased the threshold for participation. With this increase, a significant number of providers fall into the exempt category and they are now breathing a sigh of relief. However, there’s one hidden tidbit which you may have missed - the potential damage to ...

Appropriate Use Criteria for Advanced Diagnostic Imaging Services - 2018 Final Rule

by  Jared Staheli, MPP

What is the AUC program? From the CMS website: Section 218(b) of the Protecting Access to Medicare Act of 2014 amended Title XVIII of the Social Security Act to add section 1834(q) directing CMS to establish a program to promote the use of appropriate use criteria (AUC) for advanced diagnostic imaging ...

Medicare Expands Value Based Plans

by  Wyn Staheli, Director of Content - innoviHealth

In 2015, the CMS Innovation Center announced plans for new value-based Medicare Advantage plans in an effort to reduce healthcare costs while improving quality of care. This five year pilot program began in 2017 with seven states and is expanding to ten states for 2018. Results must have been positive because they ...

Veterans Choice Program

by  Wyn Staheli, Director of Content - innoviHealth

In 2017, President Trump signed into law changes to the Veteran's Choice program, which allows veterans to seek care from a civilian (privately contracted) healthcare provider, closer to home, when obtaining care through the VA has become burdensome to the veteran or requires the veteran to wait too long for an appointment.

Annual Wellness Visit (AWV)

by  Wyn Staheli, Director of Content - innoviHealth

Annual Wellness Visits (AWVs) are a preventive medicine service. It is a comprehensive evaluation and management service which is covered by payers as part of the Affordable Care Act (ACA)'s covered services and there are typically no deductibles or co-pays.

Certified Community Behavioral Health Clinics (CCBHC) Moving Forward

by  Wyn Staheli, Director of Content - innoviHealth

Certified Community Behavioral Health Clinics (CCBHCs) were created in an effort to improve access and outcomes behavioral healthcare by providing community-based mental and substance use disorder treatment through an integrative approach to care.

Provider/Patient Dynamic Changes as Result of High Deductible Plans

by  Wyn Staheli, Director of Content - innoviHealth

High-deductible plans are changing the way patients utilize medical services, therefore, providers must also adapt by adjusting both their communication and billing practices to keep pace with these changes.

Health Care Reform

by  Wyn Staheli, Director of Content - innoviHealth

Even though the health care system in the United States is one of the most expensive per capita in the world, we have a dismally low quality of care ranking. Healthcare reform (HCR) in its simplest terms is addressing these shortcomings in order to improve healthcare coverage, delivery, policies, or ...

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