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“Hospitals are seeking to hold post-acute-care providers accountable because they have more at risk under value-based payment models,” according to a May 9 story in Modern Healthcare.Read More
“Preferred SNF networks represent an aggressive new strategy by hospitals to gain more control over quality and costs in the largely independent skilled-nursing facility sector,” according to the Modern Healthcare story. Efforts like these are part of the move to value-based care, which is intended to reduce hospital readmission rates, lead to shorter lengths of stay in the SNFs, and otherwise improve quality of care for patients.
Many of you have seen the recent announcements about upcoming changes in Medicare payments. In January, the Department of Health and Human Services (HHS) announced that by 2016, 30% of all Medicare provider payments should be in alternative payment models tied to how well providers care for their patients (known as “value-based” care), instead of how many procedures or services (“volume-based”) they provide. By the end of 2018, the goal rises to 50%.Read More
HHS has recognized the need to align payers other than Medicare with this effort, noting that “making operational changes will be attractive only if the new alternative payment models and payment reforms are broadly adopted by a critical mass of payers.” In March, HHS launched the Learning and Action Network, bringing together private payers, employers, consumers, providers, states and state Medicaid programs, and other partners to expand alternative payment models into their programs. More than 2,800 organizations have already signed on.
This spring, Congress passed the long-awaited repeal of Medicare’s Sustainable Growth Rate (SGR) formula, which was signed into law by President Obama on April 16. (See more in the “doc fix” story below.)
What does this have to do with ICD-10?Read More
That doesn’t mean that ICD-10 implementation will have smooth sailing. In May 2015, two bills were introduced in Congress to either stop ICD-10 or install a transition period. The AMA has expressed support for the former bill. Nevertheless, the passage of either bill into law is considered a long shot. Providers are advised to continue their path to the conversion while keeping a close eye on Congress, according to a May 20 story in Healthcare IT News.
In mid-April the ultimate “doc fix” for Medicare’s physician payment formula finally passed. For years a perpetual legislative need, temporarily “fixing” flaws in the old Sustainable Growth Rate (SGR) formula happened in increasingly convoluted ways every time it came up for debate and passage.Read More
The MIPS aligns with Medicare’s goals to emphasize value-based over volume-based care. The five years of automatic increases represents a time for providers to complete a transition to the new kind of care, often accomplished by participating in alternative payment models such as accountable care organizations (ACOs), medical homes, and bundled payment models.
The 2015 legislation was strongly supported by the American Health Care Association, whose President and CEO called the legislation “the first step in establishing long-term stability to the profession.” To learn more about how this legislation will affect nursing home operators, click here to view a story from McKnight’s.
Quoted in this story from Kaiser Health News, the CEO of the American Medical Association also expressed approval of the legislation, saying that its passage “finally brings an end to an era of uncertainty for Medicare beneficiaries and their physicians” and helping to implement “innovative care models that will improve care quality and lower costs.” See the Kaiser story for more, including Q&A about the new 2015 law.
New features in ABILITY |COMPLETE were released in March 2015 and automatically updated for customers who have the all-payer eligibility service. Users can now:
- Print and export multiple responses. Now users can save up to 10 PDFs at one time.
- Print and export a list of all users and their status in CSV format for audit purposes. Before, users had to click on each individual to see their status.
- Add multiple responses to an existing batch. Users can now select single or multiple records from the dashboard AND from the Request History Screen and add to an existing batch, saving time and creating an easier workflow.
- Export from batch. This enhancement allows users to export a batch for STC 30 in CSV format, and save it or use for audit purposes.
- Search by first and/or last name within a batch. In the “Manage Batches” function, users can quickly locate records or determine if duplicate patient requests are in more than one batch.
- More easily set up batches, guided by a clearer sample CSV file.
ABILITY |COMPLETE customers can register for one of the weekly customer training webinars to learn more about the new features.
New features in ABILITY |EASE were released in April 2015 and automatically updated for customers who have the all-payer eligibility service. Users can now:
- Generate claims A/R reports across multiple NPIs/business units, within a timeframe that you define. You and your CFO will receive a better, more comprehensive view of A/R.
- Filter the daily summary changes report by patient last name, and split the list across all claim types. Keep your customized work list – and be more productive.
- Beginning October 1, 2015, you will easily be able to make ICD-10 code changes for any RTP or rejected claim on the ABILITY |EASE UB-04 form. ABILITY |EASE will be ready for the transition to ICD-10.
ABILITY Network has acquired System Designs, Inc (SDI), the developer of the PC-ACE Pro32TM claims processing system, a key revenue management tool for thousands of healthcare providers across the country. SDI contracts with all Medicare Administrative Contractors (MACs) in the U.S. to provide the PC-ACE software to hospitals, home health agencies and skilled nursing facilities through that network.Read More
“SDI’s customers will also now have access to the larger scope of ABILITY services,” Briggs continued. “This is another important step forward for ABILITY as we continue to deliver innovative services to meet an expanding range of provider needs.”
Today’s tip: ABILITY |COMPLETE Service Type Code Edit Function & Payer Logic
Monongahela Valley Hospital automated their transition
of care process with
ABILITY | ILLUMINATE