CMS is fixated on reshaping the ACA market that in its 2020 Payment Notice, they proposed a reduction to exchange user fees and potentially eliminates auto re-enrollment and “silver loading,” for which CMS is currently open for feedback.
Healthcare
Outcome of 2019 Final Rule for Therapists
The Centers for Medicare and Medicaid Services released the Final Rule of the 2019 Medicare physician fee schedule (MPFS). It mainly includes adding physical and occupational therapists as eligible clinicians for 2019 MIPS performance year.
Pharmacy Benefit Managers and Prescription Drugs
Pharmacy Benefit Managers (PBMs) are professionals that administer prescription drug plans for payers, employers, and CMS programs with the goal…
Optimizing Utilization Management with Technology
The technological capabilities have changed the shift from volume to value-based care. The combination of value-based delivery with actionable intelligence…
Benefits of Utilization Management
Utilization Management is an integral part of the US healthcare ecosystem used by health insurers or Pharmacy Benefit Managers (PBMs)…
A sketch on Opioid Crisis and Ways to Tackle
Headlines on opioid epidemic are engrossing the United States. There are tremendous impacts of opioid overdosage across the care continuum…
How can Technology Help HHA Providers?
Areas where technology helps providers cope with the new changes Identity Management EMPI solution to detect duplicate records Duplicate records…
Review Tools for QHP Application
The CMS provides issuers with a number of review tools to check their plans for errors in the QHP application…
Home Health Calendar Year 2019-20 Finalized Rules
CMS finalizes the calendar year 2019 and 2020 payment and policy changes for Home Health Agencies and Home Infusion Therapy…
QHP Certification Guidelines for Payers
The Patient Protection and Affordable Care Act (PPACA) and applicable regulations assert that health plans, including SADPs, must meet a…
An Introduction to Qualified Health Plan
The Affordable Care Act (ACA), defines QHP as an insurance plan certified by the Health Insurance Marketplace which provides Essential Health…
Current PHM solutions and associated challenges
In the previous section we discussed the technologies available to enhance a PHM solution, and how it helps the healthcare…