Headlines

Providers Who Perform Well Under PDPM

Under the new Patient-Driven Payment Model (PDPM), Medicare rates are determined by a formula that captures how providers measure on five care components. Those that are performing well under PDPM are effectively capturing key payment drivers and not leaving money on the table. For more on this, please see the article below. View Article Here

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Three-Day Rule To Return After The Pandemic

Post- pandemic rules for nursing home care may look different than before or even during the crisis. Though some changes made during the health emergency, telemedicine restrictions, for example, being loosened may remain, others like the three-day stay requirement may not. For more on this, please see the article below. View Article Here

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New Rules For COVID-19 Testing In Nursing Homes

Seema Verma, Centers for Medicare & Medicaid Services (CMS) Administrator, recently opened up about nursing home testing for COVID-19, noting testing should be routine. New rules presented last month require facilities to test with a specific frequency depending on the spread in the surrounding county. For frequency specificity and more on this, please see the

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SNF Occupancy Stabilizing?

With skilled nursing occupancy down-trending since 2015, the pandemic made things much more difficult for facilities. In June this year, however, Managed Medicare increased, resulting in what appear to be stabilizing revenue streams. For more on this, please see the article below. View Article Here

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Nursing Home Inspections To Resume

Earlier this year The Centers for Medicare and Medicaid Services (CMS) suspended nursing home inspections to focus attention on the COVID-19 pandemic. On Monday of this week, CMS announced it will resume inspections for all providers that are Medicare and Medicaid certified. For more on this see the article below. View Article Here

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Medicare Therapy Rates Reduction Proposed

The Centers for Medicare & Medicaid Services (CMS) is proposing reductions to Medicare Part B reimbursement for physical therapy (PT) and occupational therapy (OT). For more on this proposed 9% cut, please see the article below. View Article Here

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2.2% Medicare Boost For Skilled Nursing Facilities

The Centers for Medicare and Medicaid Services (CMS) have announced that nursing homes will receive a $750 million Medicare pay increase in 2021. For more on this and insight into the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) please see below. View Article Here

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Medicare Advantage Continues Upward Trend

Between the fourth quarter of 2018 and the fourth quarter of 2019, Medicare Advantage increased to account for 34 percent of Medicare.  It’s predicted that this rise will continue this year. For more on this, please see the article below. View Article Here

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Telehealth Reimbursement Rates Being Assessed Post-COVID

CMS Administrator Seema Verma has indicated that telehealth expansions put in place during the pandemic may be permanent after a thorough assessment. For more on this with a look into three areas being examined before permanent telehealth expansions are finalized, please see the article below. View Article Here

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Medicare Funds On Hold For Facilities Acquired Early This Year

Facilities that were acquired early in 2020 have noticed the much needed Medicare relief fund meant to help weather the financial strains of the COVID-19 crisis, stuck in limbo. Funds were distributed to providers based on their 2019 Medicare reimbursements by the Department of Health and Human Services (HHS), who sent money to the account

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Enhanced Enforcement Actions For Nursing Homes Unveiled By CMS

The Centers for Medicare and Medicaid Services (CMS) unveiled enhancement enforcement actions for nursing homes based on COVID-19 data and inspection results. This announcement came on June 1, 2020, expanding on the previous actions taken by CMS to assure safety and security in nursing homes during the COVID-19 crisis. Facilities with persistent infection control violations

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PDPM Provides ‘Fiscal Lifeline’ During COVID-19 Crisis

In October of last year, the Patient-Driven Payment Model (PDPM) was implemented, more closely linking Medicare reimbursement with resident acuity. The current COVID-19 crisis appears to have validated the federal government’s decision to replace the RUGs model with PDPM. For more on this see the article below. View Article Here

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Recommendation For CMS To Protect VBP Progress

To protect the progress of the value-based payment reform, the American College of Physicians (ACP) recently reached out to the Centers for Medicare & Medicaid Services (CMS) recommending to extend flexibilities in the Quality Payment Program (QPP) to protect clinicians against long-term effects of the COVID-19 crisis. For visibility to the proposed flexibilities ACP outlined

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Nursing Homes To Report COVID-19 Cases Weekly

The Centers for Disease Control and Prevention (CDC) is requiring all nursing homes to report COVID-19 information every seven days. This data will serve to capture the trajectory of the disease and help providers gather the necessary resources.  For more on this please see the article below. View Article Here

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CMS Rule Encourages MA Plans To Increase Telehealth Access

The Centers for Medicare and Medicaid Services (CMS) has finalized rule changes that encourage Medicare Advantage (MA) plans to increase their telehealth benefits. Now, MA plans will be able to cover a wider range of telehealth specialty providers. CMS is also looking to ease policies for rural healthcare to make MA offerings available to rural

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The Biggest Challenges Skilled Nursing Facilities Face Today

Currently, skilled nursing facilities (SNFs) are facing a very challenging environment. This article presents new and existing opportunities for SNFs to succeed. Plante Moran’s report is referenced, which compares around 15,000 Medicare-certified SNFs to identify their operating, revenue and expense metrics. See below for interesting takeaways. View Article Here

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CMS Releases Providers’ Staffing Data To Assess PPE Needs

The Centers for Medicare & Medicaid Services (CMS) announced they will be using providers’ staffing totals to identify their personal protective equipment (PPE) needs during the coronavirus pandemic. CMS also plans to freeze nursing home inspections star ratings during the emergency. For more on this, please see the article below. View Article Here

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2021 CMS Proposed Payment and Policy Changes For SNFs

Recently, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule for skilled nursing facility (SNF) payments for the coming year. If finalized, the rule would see nursing homes receive a 2.3% Medicare pay bump, update the SNF prospective payment system (PPS) wage index and update the way IDC-10 codes map under the

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COVID-19 Payer Updates 4/21/20 – Access Advantage

Payer COVID-19 policies continue to come in, with anticipated additions over the days and weeks ahead. Payers are relaxing their policies and implementing emergency actions to accommodate the influx of healthcare services needed at this time. Please see below for the latest update(s) since our last alert. Ohio Department of Medicaid (ODM) – In response

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CMS Temporarily Postpones Facility Inspections

In light of the COVID-19 emergency, the Centers for Medicare and Medicaid Services (CMS) has temporarily postponed facility inspections. Focus has instead shifted to infection control and Immediate Jeopardy situations.  For more on this as well as a look at the three-pronged approach to identify which providers, hospitals and labs across the country are prepared

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COVID-19 Payer Updates 4/1/20 – Access Advantage

Payer COVID-19 policies continue to come in, with anticipated additions over the days and weeks ahead. Payers are relaxing their policies and implementing emergency actions to accommodate the influx of healthcare services needed at this time. Please see below for the latest update(s) since our last alert. Anthem – Beginning March 26, 2020 Anthem health

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COVID-19 Payer Updates – Access Advantage

Payer COVID-19 policies are beginning to come in, with anticipated additions over the days and weeks ahead. Please note several payers have made changes to their prior authorization (PA) protocols. Aultcare – Recently developed a policy to make it easier to access medical care virtually. The policy, applicable to all medically necessary services, will be

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Managed Care Plans and COVID-19

The Centers for Medicare and Medicaid Services (CMS) has issued guidance to Medicare Advantage Plans to address their obligations and flexibilities with regards to the emergency caused by COVID-19. This article includes Medicare Advantage special requirements, permissive actions and an Ohio bulletin notifying companies of their obligation to provide access to the healthcare services to

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CMS Coverage And Payment Information For COVID-19

Late last week The Centers for Medicare and Medicaid Services (CMS) posted information regarding COVID-19 Medicare coverage and payment. This article focuses on coverage for diagnostic tests, vaccines, inpatient hospital care services, quarantines and much more. Please see below post. View Article Here

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Nursing Home Closures Accelerating

A study by Leading Age recently showed that over 500 nursing homes in the US have closed in the past four years. These closures caused by several factors including, but not limited to, rising costs, pressures from payers and increased competition. This article highlights changes the industry is facing, as well as how managed care

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Changes To Prior Authorizations This Year

The CMS will be looking to “Free physicians to spend time caring for their patients,” this year according to CMS Administrator Seema Verma. After analyzing thousands of comments received and hosting multiple listening sessions, CMS is looking into solutions this year to improve the prior authorization process. For more on this, see the article below.

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PDPM Strategies For Success

In the first few months of the Patient Driven Payment Model (PDPM), there have proven to be a few rather successful strategies. Two of the most impactful things that Skilled Nursing Facilities (SNFs) are focusing on are data and clear communication of their high acuity to hospitals. For more on this please see the article

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SNFs More Memorable Moments Of 2019

An interesting look back at 2019 and a few of the more interesting moments that were more or less overshadowed by the shift to PDPM. From an account of the impact ACO’s have had on SNF’s, to a piece on one state’s attempt to remove long-term residents from managed Medicaid, this article touches on some

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Using CMS Data To Reduce Short-Term Stays

This article is a great example of a skilled nursing facility (SNF) using CMS data to react and respond to issues affecting their quality of care. Showcased, a facility that was able to reduce short-term stays for Medicare by 45% and able to rehabilitate patients more efficiently than surrounding SNFs. For more on this, please

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Over 20 Million Americans To Turn 80 This Decade

Now that 2020 has arrived, an overwhelming number of Americans will be reaching the age where high levels of personal care are needed. Studies have shown that around the age of 80, individuals become notably frailer and health-related issues skyrocket. The Forbes article below notes that over 77 million Americans will reach the age of

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High Readmissions Will Cost Hospitals

Too many readmissions within 30 days will cause CMS to penalize over 2,500 hospitals in 2020 according to a Kaiser Health News report. These penalties are estimated to cost hospitals over $563 million over the year. Kaiser’s report notes that 83% of the 3,129 hospitals evaluated in the Hospital Readmission Reduction Program received a penalty,

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Post-Acute Shifts Focus From Volume To Value

Last week, the American Health Care Association and National Center for Assisted Living hosted the first Population Health Management Summit which focused primarily on how the healthcare landscape is shifting from volume to value. Medicare Advantage plans, positioned to drive payment and delivery reform, are expected to become the dominant form of Medicare by the

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What If More Patients Were Sent Directly To Skilled Nursing Facilities?

Three health networks in Boston formed an accountable care organization (ACO) this year, the Beth Israel Lahey Performance Network (BILPN). This ACO sees an opportunity in sending patients directly to a skilled nursing facility (SNF) without requiring a three-day hospital stay. BILPN’s three-day waiver program is meant to provide a path for patients who don’t

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Home Health Becoming Most Likely Post-Acute Referral Destination

According to the 2019 Industry Trend Report from Trella Health, skilled nursing facility (SNF) admissions are dropping across the country while home health agencies have become the most likely post-acute referral destination. Some states have seen a decline in SNF admissions anywhere between 14% and 26%. For more on this, see the article below. View

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Managed Care Enrollment Up 10% This Decade

Managed Care continues to grow! This decade, there has been a 10% increase in Medicare Advantage enrollment for all eligible beneficiaries. For more on this and how the majority of seniors are more than satisfied with Managed Care, see the article below. View Article Here

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Hospitals Demand National Standards For Prior Authorizations

Hospitals are demanding national standards for prior authorizations regardless of which Payer they are working with. Hospitals often believe they have followed the required steps and process flawlessly, only to discover their claim was denied. This inevitably leads to a painful and lengthy appeals process. This article addresses the pain points many providers are feeling

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New Rule Requires Hospitals To Provide Skilled Nursing Quality Data At Discharge

CMS has finalized a new rule requiring hospitals to give patients better visibility to their post-acute provider choices. This rule will not impact the anti-steering regulations that prevent hospitals from recommending specific skilled nursing facilities, but rather enlighten the patient to make a more informed decision to their post-acute care while also considering their goals

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SNF’s Negatively Impacted By Prior Ownership

With mergers-and-acquisitions becoming more prevalent in the skilled nursing space, many operators are experiencing issues with negative press, difficulties obtaining bank loans, and even Star rating impacts bubbling up from the previous owners. For more on this, please see the article below. View Article Here

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Michigan Number One In Cybercrime Complaints

Cyberattack prevention is more important than ever. The overwhelming majority of ransomware attacks are targeted towards small businesses that can’t afford to spend on defense. Companies have been found to pay up to four times as much to resolve an attack than they would have to prevent one. As PHI is incredibly valuable, it will

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UnitedHealthcare’s 2020 Medicare Advantage Plans To Expand

With their 2020 nationwide expansion, 90% of Medicare beneficiaries will have access to a UnitedHealthcare Medicare Advantage plan. Through our close relationship with UnitedHealthcare, we’ve brought contracts to multiple facilities recently. If working with UHC is of interest to you, connect with us to see how our strategy may be mutually beneficial. View Article Here

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CMS Memo- PDPM HIPPS Coding for MA Plans

On September 26th CMS released a Medicare Advantage (MA) Plan Memo updating specifics surrounding HIPPS code sets related to PDPM implementation, launching today, October 1, 2019. (Memo 1) These details are inclusive of iSNP and MyCare. The Memo relates to two previous CMS MA Plan Memos in 2014. (Memo 2) (Memo 3) More specifically, the

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I-SNP Model Shifts Care To Less Costly Clinical Setting

Research has found nursing home residents enrolled in UnitedHealthcare’s Medicare Advantage Institutional Special Needs Plans (I-SNPs) are significantly more likely to use skilled nursing services than those with a Medicare fee-for-service plan. For more on this, see this article from @mcknightsltcn. View Article Here

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SNFs Prepare For Rising Acuity Of Patients

Skilled facilities and hospitals are observing patients with higher complexities being discharged to SNFs much sooner. Because of this, SNFs are trying their best to prepare for the rising acuity of patients coming in. This article from @skilled_nursing details the variances seen by geographic location, challenges expected and suggestions on how SNFs can partner with

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What Is PDPM?

The Centers for Medicare and Medicaid Services (CMS) will soon be replacing the Resource Utilization Group (RUG) Version IV payment model with the new Patient Driven Payment Model (PDPM). The current RUG-IV system focused on payments based on how much therapy services were received. However, PDPM places patients into case-mix groups based on certain clinical

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CMS Requested To Simplify Three-Day Stay Rule

Currently, Medicare beneficiaries must have a three-day hospital stay to receive subsequent fully covered skilled nursing services. Hospitals admitting on an observation basis rather than inpatient has lead to very costly Medicare denials. The American Health Care Association (AHCA) CEO has asked Centers for Medicare & Medicaid Services (CMS) to eliminate uncertainty on the Medicare

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MA Growth Of The Five Biggest Payers

Managed Care is growing! Here is a look at the increase the five biggest Payers have seen in Medicare Advantage membership in the last year. Aetna leads the pack with an over 30 percent increase over last year. See the article below for this and more.   View Article Here

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Payers Watch Rehospitalization

Rehospitalization is the most closely tracked metric for all payers. A recent Dartmouth study reduced RTH by 31%, predominately for LTC residents. For more on this, see this article from @mcknightsltcn: View Article Here

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CMS Will Help MA Plans Become More Competitive

CMS has announced a new rule that will help Medicare Advantage plans to better compete with one another. This competition will be possible due to the types of benefits they will be able to offer next year including transportation, home environmental improvements and many more. For more on this, read the @HeartlandInst article below. View

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Medicaid Managed Care Bill To Expedite Claims Payment

Illinois identified the Medicaid application process and payments to providers as too slow. This article lays out how the state’s new law requires managed care organizations (MCO’s) to pay claims within 30 days while also streamlining the application processes ability to identify eligibility. View Article Here

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SNFs Looking To Improve Payer Relationships

Skilled Nursing Facilities are experiencing the necessity of a positive Payer relationship. Medicare Advantage plans are focusing on strategies that will have the greatest impact, affecting the most lives. To succeed, SNFs must learn to identify a Payer’s top priorities and build a solid foundation of communication, ensuring both parties are on the same page

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Long-Term Managed Medicaid Could Disappear In NY

There is currently a New York state waiver amendment that would remove long-term managed Medicaid for patients living in SNFs. If approved, this would transition back into a fee-for-service Medicaid for stays over three months and would be implemented at the beginning of 2020. Other states could look to similar strategies as most states are

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Demand For SNF Properties May Increase This Year

A national survey on healthcare markets revealed that skilled nursing facility properties demand may increase this year. This as opposed to 2018’s forecast which showed a steady or shrinking demand. For more on this please see the @mcknightsltcn article below. View Article Here

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SNFs Must Define Who They Are

Skilled Nursing News sat down with the CEO of Dycora Transitional Health and Living to describe how the industry has changed through the years, to provide pointers for new SNFs and to elaborate on how a SNF can perform to its full potential. Focusing on your communities needs, telling your story, and being proactive rather

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CMS To Increase Drug Price Transparency

The Trump Administration has finalized adjustments to Medicare Advantage and Medicare Part D to ensure patients have greater transparency in the cost of prescription drugs, along with improved visibility to their options. Under this new rule, the Explanation of Benefits document that Part D enrollees receive should now include notice of drug price increases as

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SNF Star Rating Correlates To Profitability

Skilled Nursing Facilities are discovering that investing in their Staffing Star rating doesn’t necessarily lead to profitability. Rather, SNFs would serve better by focusing their attention on their survey and quality ratings, which show the biggest impact to their CMS five-star rating. This Star rating is indicative of the operating margin a SNF should expect

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SNF $887 Million Boost With CMS Proposed PPS Update

Through CMS’s proposed update to the prospective payment system (PPS) for the federal fiscal year 2020, SNF’s would see an increase in Medicare payments of $887 million. 2020 marks the implementation of the Patient-Driven Payment Model (PDPM), which focuses on clinical conditions as opposed to the volume of care provided. Under this model, CMS placed

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New Strategy Could Overhaul Fee-For-Service

The U.S. Department of Health and Human Services (HHS) revealed new voluntary programs that could overhaul the fee-for-service model, set to launch at the beginning of 2020. The first model is targeted towards small primary-care practices, while larger practices and health systems have other choices such as “professional” and “geographic” options. For more on this,

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CMS Chief Verma’s “Comprehensive review” of Nursing Home Safety and Quality Standards

CMS Chief Seema Verma recently announced a “comprehensive review” of safety and quality standards for nursing homes. In this post, Verma highlights changes that have already been made, including stricter staffing requirements as well as aligning reimbursements with performance. Verma’s post reminds that the federal government will continue to overhaul its regulations for nursing homes

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Skilled Nursing Facilities Sudden Star Ratings Decrease

Approximately 36% of SNFs experienced a drop in stars this week according to the American Health Care Association (AHCA). With many providers losing one or more stars in quality, many SNFs trace this star decrease back to nurse staffing which has the greatest impact on quality. Quality has been a major focus as Centers for

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Why Nursing Home Revenue Is Declining

While expenses continue to rise, revenue is declining for nursing homes according to a report provided by @MarcumLLP. This article from @skilled_nursing outlines how nursing homes arrived at an average loss of four cents per patient day in 2017. A combination of lower occupancy rates along with many residents now being enrolled in managed care

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With PDPM On The Horizon, SNFs Must Continue To Focus

With the new PDPM model less than six months away, SNFs will need to continue to focus on their day-to-day deliverables to ensure their STAR rating, hospital readmissions and other details are not impacted. This article from @skilled_nursing notes how the transition from the RUG-based world to PDPM, a monumental payment overhaul, could easily steal

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“The Greatest Opportunity” For SNF’s

When contemplating what solutions might help SNF’s thrive in the future, one suggestion would be to evolve into a short-stay facility that would essentially cut the emergency room “out of the equation entirely”. This article from @skilled_nursing notes “the greatest opportunity” would be for SNF’s to partner with Medicare Advantage plans and prove their ability

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Medicare Advantage- Coordinated, Value-Based Care

Thanks to the care navigation that Medicare Advantage provides, consumers are experiencing value and simplicity. For several reasons, MA enrollment has increased over 30% in the past four years. A privately-run system rather than government-run, MA is proving to be valuable to consumers in both quality of care as well as financially. Through care navigation,

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Skilled Nursing Facilities Payment Will Be Impacted By PDPM

When the Patient-Driven Payment Model (PDPM) takes effect in October 2019, Payers using the RUG system will have until September 30, 2020 to adjust their rate calculations. With the variety of changes nearing, SNF staff will be forced to pay closer attention than ever before to their coding and billing. This article from @skilled_nursing sheds

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Medicare Advantage Is The Future Of Medicare

During a discussion at a San Diego skilled nursing conference, former Speaker of the House Paul Ryan stated “I believe the future for Medicare is in the Medicare Advantage type of space”. In this conversation, Ryan praised Medicare Advantage plans as a means of preventing financial disaster to the Medicare program. Currently Medicare Advantage plans

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SNF’s Anticipate 6% Increase In Liability Claims This Year

According to the American Health Care Association and professional services firm Aon, nursing homes will see a 6% increase in liability claims this year, composed of a 3% increase in claims frequency and a 3% increase in claim size. Providing little to no write-offs, Access Advantage helps our members get the most possible dollars out

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Skilled Nursing Facilities Struggle With Inefficient Transfers

Choosing the right SNF is a very important decision for patients and families when transferring from the hospital. If a SNF that does not meet their need is selected, they run a much higher risk of re-hospitalization, longer length of stay and mortality. This article from @skilled_nursing details out how @UnitedHospFund and others are looking

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DeWine Orders To Rebid State’s Medicaid Contracts

With a goal of saving taxpayers’ dollars and securing a better deal for the state, Gov. Mike DeWine has ordered the Ohio Department of Medicaid to rebid the state’s contracts with private health insurance companies manage health care dollars. This article from @daytondailynews sheds light on this and more! View Article Here

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$2B SNF Payments Cut In 2020 Requested By MedPAC

Though Congress is not obligated to incorporate such requests into actual policy, the Medicare Payment Advisory Commission has asked to reduce SNF funding by $2 billion in 2020. See more on this from the @skilled_nursing article. View Article Here

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“Pathways to Success” Add to SNF Pressures

ACO’s currently have up to six years to avoid taking risk under the current Medicare Shared Savings Program (MSSP). However, the “Pathways to Success” proposed by CMS would cut this timeframe to two years. See more on this in the article from @skilled_nursing. View Article Here

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SNF’s Must Adapt To Survive

These are very challenging times for SNF’s. This article from @skilled_nursing details out suggestions for smaller SNF’s to stay afloat until the “silver tsunami” arrives. View Article Here

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Quality Incentive Programs – Are They Working?

New reports show that Medicare’s hospital readmission reduction program may be causing an increase in mortality. Also under fire, rewards and penalties based on quality measures, due to their focus on processes rather than outcomes. This article from @modrnhealthcr expounds on whether or not quality incentive programs are working. View Article Here

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Medicare Advantage Plans Have More Flexibility In 2019

Under new CMS guidelines, Medicare Advantage plans have more flexibility in 2019 with regard to the benefits they are permitted to offer. This report prepared by @millimanhealth and commissioned by @BMAlliance is one of the more comprehensive reviews that we’ve seen. View Article Here

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Trinity Community Receives Employer of Choice Award

We are proud to announce that our member, United Church Homes’ Trinity Community has been recognized by LeadingAge Ohio with the bronze Employer of Choice Award for 2018-19. For more information about this well-earned award, please follow the link below. Trinity Community Receives Employer of Choice Award

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Long-Term Optimism Boosting Skilled Bed Prices Despite Low Occupancy

By Alex Spanko | November 25, 2018Investment in skilled nursing facilities hasn’t slowed down despite persistent dark clouds surrounding the industry’s outlook. One of the overarching themes this past conference season — including at the summits held by the American Health Care Association (AHCA) and the National Investment Center for Seniors Housing & Care (NIC) —

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The ABCs of Medicare Advantage STAR Ratings

“Why are payers still struggling with a lot of complicated tasks? What holds the key to solving their problems?” Would you be surprised if the answer to the above question is patients themselves? Although payers are fairly young in the US healthcare dynamics, they have become a substantial element in the transforming value-based healthcare. Considering

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Aetna Announces Biggest Medicare Advantage Expansion in Its History

Oct 22 2018 Dateline City: HARTFORD, Conn. Aetna’s 2019 Medicare plans offer enhanced benefits and greater value HARTFORD, Conn.–(BUSINESS WIRE)–Aetna (NYSE: AET) announced its 2019 Medicare plans, featuring expanded plan options with low or $0 monthly plan premiums in many areas, enhanced benefits and a more personalized member experience. “We are proud to be a leader

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New Payer Announcement: FrontPath

Access Advantage is excited to announce a new addition to our roster of Payers, FrontPath. FrontPath Health Coalition, based in Perrysburg, Ohio, is a Self-Insured Plan covering individuals and their families in NW Ohio, NE Indiana and SE Michigan. The Coalition was founded in 1988 by eight Fortune 500 employers to provide a competitive alternative

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Access Innovations featured in Press Release

We are proud to provide a spotlight to our Vice President of Value Based Programs, Bryce Henson, for being featured in a press release focusing on a collaboration between MCG Health and Cadalys. MCG Health, a leading provider of informed care strategies and part of the Hearst Health network, has partnered with Cadalys, an innovator

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CMS Announces BPCI Advanced for Hospitals and Physicians- Submissions Due March 12th

CMS has announced the long awaited BPCI Advanced, modeled for hospital and physician participation.  The 2.0 version of BPCI, Advanced builds on outcomes of the Models 1-4 BPCI Pilot concluding Q3 2018. Quick synopsis: CMS applications are accepted January 11-March 12, 2018. BPCI Advanced is an Advanced Alternative Payment Model (APM) under the Quality Payment Program. A voluntary model, BPCI Advanced can coexist in

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BPCI Advanced Announced!

Today, the Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (Innovation Center) announced the launch of a new voluntary bundled payment model called Bundled Payments for Care Improvement Advanced (BPCI Advanced). Under traditional fee-for-service payment, Medicare pays providers for each individual service they perform. Under this bundled payment model, participants

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BREAKING: CMS delays expansion of bundled payment programs

By Elizabeth Whitman | March 20, 2017 The CMS has delayed the expansion of a major bundled payment pilot, Comprehensive Care for Joint Replacement, and the implementation of its bundled payment initiatives for cardiac care from July 1 to Oct. 1, 2017, according to an interim final rule posted to the Federal Register.

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We’re Moving!

Access Companies offices will be closing Friday, November 18 at noon to move to our new location at: 355 E Campus View Blvd Suite 110 Columbus, Ohio 43235 We will re-open by noon on Monday, November 21. All other contacts will remain unchanged: PO BOX 340006 Columbus, Ohio 43234 Office phone: 614-345-5001 Office email/service box:

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2016 PAC-Related Medicare Alternative Payment Models

Access and our contracted strategic consultant, Avalere, have created a national map for use with leadership, staff and Board to assist in explaining the many Medicare PAC Pilot activities occurring. Access Innovations is participating in a Model 3 Bundled Payment Pilot with 12 PAC providers in Ohio indicated by blue dots. The April 1st Comprehensive

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Medicare Mandatory Joint Bundles: April 2016

Comprehensive Care for Joint Replacement (CJR) CMS has released its final rule for Comprehensive Care for Joint Replacement (CJR) which puts which puts 790 hospitals on notice that hip and knee replacement reimbursements from Medicare will be tied to cost containment and high standards for patient care. CMS will test the initiative at those hospitals

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OPERS 2016 changes

Individuals who are Medicare eligible with OPERS health coverage will be changing from a sponsored pension system to having to choose supplemental coverage. Click here to read The Columbus Dispatch article on changes affecting OPERS retirees. OPERS Humana/MedMutual members are now able to personally select their plans in 2016. OPERS 2016 announcements and changes for

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Access Innovations: CMS Model 3 Bundled Payment Pilot

Access Innovations, a CMS Model 3 Bundled Payment Pilot, allows us to begin working under the value based payment methodology currently offered by CMS. A new payment model, it’s designed to coordinate care, improve quality and improve efficiency. Our Pilot offers fiscal analytics based on past Medicare claims data, care redesign resources such as evidence

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Contracting Updates

This time of year we are working with each Plan on upcoming 2016 changes including: Medigold – will be revising their episodic payment methodology to shorter episodes, and a new quality design in which more highly Star rated SNFs will receive an increased rate. They are actively reviewing their network, advising 1 and 2 Star

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Revenue Cycle Tips & Tricks

Attention Members: Please remember to send an email to service@access-advantage.com after importing claims to Zirmed. You will receive a confirmation email with the following response: “Access Advantage has received your claims submission request. We are currently reviewing coding specifications to assure clean claim submission to payer. Please allow 24-48 hours for AA review. Please check

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Transportation changes for Molina and United Healthcare MyCare members

Molina Healthcare has a new vendor, Secure Transportation, which will take over services currently provided by Logisticare for Medicaid members on November 1, 2015. MyCare Ohio and Medicare members will start services on January 1, 2016. Secure Transportation will contract with medical transportation providers throughout Ohio to provide quality “door-to-door” transportation to our members. November

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Diagnosis Code Reminders and Updates

ICD-10 Reminder that ICD-10 coding is needed after dates of service 10/1/2015. Please note that your Access Advantage membership includes free access to ZirMed’s online coding tools. Please contact Amanda Ratliff or Anna Nelson for more information and demo. ICD-9-CM/ICD-10-CM Diagnosis codes 294.10/F02.80 (Dementia in diseases classified elsewhere without behavioral disturbance), and 294.11/F02.81 (Dementia in

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