Blue Cross Blue Shield just announced that they’re pulling out of 85 counties, over half of the counties in Georgia including Chatham county. This provider is the largest health insurer in the state of Georgia. The decision stems from…
If there is one universal given in healthcare today, it’s the complexity and fear of the unknown of the Quality Payment Program (QPP), or MACRA, whichever title you prefer. From provider feedback, we have crafted an actionable approach to allow…
Transitional Care Management (TCM) bolsters the involvement of primary care physicians in the coordination of post-discharge care to reduce readmission. Patients with moderately complex diagnoses are eligible to receive TCM services during a 30-day window after their discharge from an…
The 2,171-page final rule contains several differences that crosswalk existing PQRS measures to new finalized metrics. The simplest way to ensure your PQRS-to-MIPS transition goes smoothly is to search each quality metric and data submission method here. Several important tables…
Hierarchical Condition Category (HCC) coding is a payment model implemented by CMS in 2003 to assign a Risk Adjustment Factor (RAF) to individuals with chronic illnesses based upon a combination of their health conditions and demographic circumstances. HCCs are split…
The Centers for Medicare & Medicaid Services (CMS) proposed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) in late April, 2016. This release announced a fundamental overhaul of physician payment methodologies from a model reimbursing each individual service…
As The Department of Justice (DOJ) recently filed Antitrust lawsuits against both the Connecticut-based Aetna and Indianapolis-based Anthem “Mega-Mergers,” the DOJ is suggests a February start date to the trial. With Aetna aiming to complete a $37 billion acquisition of Humana…
Developments continue regarding the proposed mergers between Anthem/Cigna and Aetna/Humana. Yesterday, the Justice Department reported they will likely file lawsuits this month to halt both proposed mergers. If the Justice Department does take action, it may significantly delay any merger. …
The Office of the National Coordinator for Health IT recently released defined interoperability measures as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). These measures intend to clarify what exactly it means to, “achieve widespread exchange…
If the proposed Anthem/Cigna and Aetna/Humana mergers are allowed to proceed, the combined entities will control roughly 90 percent of both Georgia’s individual health insurance market. Additionally, these entities will subsequently control 90 percent of both the Medicare Title XVIII…