Rural Health

Rural Americans face different health disparities than urban Americans requiring the need for different rules and programs. National Rural Health Association’s Policy Institute helps facilitate state offices with their individual rural communities to remove barriers to healthcare access. The purpose is to ensure enough healthcare access and healthcare delivery systems to promote a healthy rural America.  

Resources

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Leveraging Hierarchical Condition Category (HCC) Coding to Improve Overall Healthcare

by  Kem Tolliver, CMPE, CPC, CMOM

Diagnosis code usage is a major component of optimizing HCCs to improve overall healthcare. Readers will gain insight into how accurate diagnosis code usage and selection impacts reimbursement and overall healthcare.

End-Stage Renal Disease Risk Model Updates for 2023

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

For the first time, ESRD Medicare beneficiaries were permitted to enroll in Medicare Advantage plans beginning in 2021. Since that time, CMS has been working to revise the program to reduce costs, improve quality, and drive benefits. Effective January 1, 2025, one such change will include a definition change for "oral-only drugs." Why is Medicare changing the definition of these drugs and how will that be a driving force in advancing care models for ESRD in the future?

Calendar Year 2023 Medicare Physician Fee Schedule Proposed Rule

by  Amanda Ballif

The Centers for Medicare and Medicaid Services (CMS) is soliciting public comments on proposed changes for Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues effective on January 1, 2023 and thereafter. The Calendar Year (CY) 2023 PFS proposed rule is one of several proposed rules aimed at increasing equity in health care.

2022-03-03-MLNC - 2022 Payment, Quality, & Policy Changes

by  CMS - MLNConnects

News - Ambulance Prior Authorization Model Expands April 1 - Nutrition-related Health Conditions: Recommend Medicare Preventive Services - Claims, Pricers, & Codes - HCPCS Application Summaries & Coding Decisions: Drugs and Biologicals - Events - ICD-10 Coordination & Maintenance Committee Meeting — March...

IPPS and DRG's: What it Means

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Understanding hospital pricing can get complicated, so we have broken it down according to CMS and the acute Inpatient Prospective Payment System, also known as IPPS. Find-A-Code uses IPPS for inpatient pricing with our MS-DRG grouper. The following information comes from CMS.gov and answers the most common questions regarding DRGs ...

Understanding UCR Inpatient Fees used on DRGs

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

CMS- Patient Driven Payment Model Effective October 01, 2019

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

According to CMS, In July 2018, CMS finalized a new case-mix classification model, the Patient-Driven Payment Model (PDPM), that, effective beginning October 1, 2019, will be used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for classifying SNF patients in a covered Part A stay. Using the new Patient-Driven ...

So How Do I Get Paid for This? APC, OPPS, IPPS, DRG?

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

You know how to find a procedure code and you may even know how to do the procedure, but where does the reimbursement come from?  It seems to be a mystery to many of us, so let's clear up some common confusion and review some of the main reimbursement systems.  One of the ...

New Payment Model launched by CMS- Bundled Payments for Care Improvement Advanced (BPCI Advanced).

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Medicare Diabetes Prevention Program (MDPP) Expanded Model Information

by  Jared Staheli, MPP

Diabetes treatment places an ever-increasing strain on the resources of the U.S. healthcare system. CMS estimated that in 2016 alone, Medicare incurred an additional $42 billion in costs due to the number of beneficiaries with diabetes. The best way to keep these costs down in the future is by preventing ...

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