Data Exchange Standards: Fast Healthcare Interoperability Resources (FHIR) & Blockchain
The Centers for Medicare and Medicaid Services (CMS) now supports improved health care interoperability efforts through applications that enable a data exchange between two disparate computer systems. One type of application programming interface (API) or data exchange standard that is being used more frequently by EHR vendors is Fast Healthcare Interoperability Resources (FHIR). Developed by […]
Getting Paid for Transitional Care Management (TCM)
Medicare adopted transitional care management (TCM) payment codes in 2013 to encourage clinicians to provide TCM services after beneficiaries were discharged to the community from medical facilities. As a result, Medicare spending on TCM services increased over 200 percent between 2013 and 2016, and studies show that these services significantly reduced cost and mortality in […]
Medicare Payment Advisory Commission (MEDPAC) Reimbursement of Evaluation & Management Codes
MEDPAC recently issued a report to Congress. It reviewed the reimbursement levels for office-based E/M codes versus procedural codes. The commission recommended a significant increase in the reimbursement of E/M codes. The increase ranged from 5% to 30% as a pay increase. The commission stated that over time there has been a “passive devaluation” of […]
Medicare Advantage Star Rating and the Provider: Rewarding, Complex and Competitive
CMS created the Star Ratings system in 2008 to help seniors compare quality and performance among Medicare Advantage (MA) Part C plans and Part D prescription drug plans (PDPs). Insurance companies also benefit, as a plan’s star rating influences patients and directly affects membership growth. In 2012, CMS upped the ante by linking premiums and […]
