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Latest Medicare rule changes aim to increase payment rates and improve health equity and quality of care for those with end-stage renal disease. On Oct. 29, 2021, The Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates payment rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal […]
The post CMS Announces Changes to ESRD Payment Model appeared first on AAPC Knowledge Center.
Create successful cross-training programs using this time-tested instructional design model. ADDIE is an instructional design model that helps instructors, trainers, facilitators, and educators plan and create courses and training programs. It is the most well-known framework for instructional design and is used both as defined and as a base component in other models. The ADDIE […]
The post Cross-train Employees Using the ADDIE Model appeared first on AAPC Knowledge Center.
CMS selects primary care payment model participants
According to Becker’s Hospital Review, “CMS chose 916 primary care practices and 37 regional health plan partners as participants in its new payment model called Primary Care First.
PCF was designed to decrease the amount of avoidable hospital visits and total cost of care through performance-based adjustments. The practices CMS selected as participants generally include primary care clinicians who serve seriously ill populations in high need of care.
Participants will start using the alternative payment model Jan. 1, 2021, and CMS plans to test the model for five years.”
The post CMS Selects Primary Care Payment Model Participants appeared first on The Coding Network.
A troubling trend in the medical coding industry is a misleading split model where companies will have resources both onshore and abroad but not disclose which personnel are performing the services. Some use their domestic resources almost exclusively for client facing interactions, such as sales and operations, but send all of the coding work to be performed offshore to reduce their costs. This creates the illusion of a US based workforce, but it comes with the dangers of offshore medical coding.
The dangers of offshoring coding work are twofold: 1) accuracy, and 2) privacy. Coding is a highly specialized cognitive function that cannot be commodified. This isn’t bandages or simple repetitive tasks. It is a service that requires a great deal of specialized knowledge and critical thinking that takes years of practice to hone and constant education to ensure that the coder is kept abreast of updates to their field. As an external auditing provider, The Coding Network has audited a bevy of offshore coding vendors. Our overwhelming experience is that offshore coding is suboptimal and greatly concerning for organizations that utilize their services.
Additionally, there are no HIPAA laws outside of the United States, raising privacy and security concerns. A vendor might assure their clients that their overseas facility is secured, but if there is a breach of an organization’s PHI the only mechanism to protect themselves against the vendor would be a contractual claim, i.e. a breach of the terms of a BAA, not an enforcement action. Trying to sue an entity that maintains most of its operations and assets offshore makes any recovery incredibly difficult and the likelihood of recompense murky at best. You wouldn’t even know your information is leaked until it ends up in the wrong hands and since it would be impossible to trace without a candid engagement by the vendor, there is little that could be done.
Remember that the PHI in question is that of an organization’s patients. What would the patients think if they discovered their personal information was being sent abroad for no other reason than to save the organization money. This cost savings to an organization is nominal and more often than not the patients do not realize any of the savings in their billings. From a public relations standpoint, this will likely not go over well with a practice’s patient base and could result in a loss of business and/or reputational harm.
Whenever dealing with a coding vendor it is important to make sure they are doing the work in the USA. One tip is to ask for a clause in your contract that requires US-based coding. Additionally, look out for pricing that seems too good to be true. If you’re paying a bargain basement price for your coding work you will be getting bargain basement quality and security.
The post Split Model Service Providers (Medical Coding Vendors with Offshore and Onshore Operations) appeared first on The Coding Network.
CMS has delayed the start date of its Emergency Triage, Treat and Transport model from May 1 until this fall.
CMS selected 205 participants in February for the five-year ET3 model. CMS said it is delaying the start date because participants now are focused on responding to the COVID-19 pandemic.
The new model aims to give ambulance care teams more flexibility in how they triage emergencies. The goal of the payment model is to improve care quality and cut costs by reducing unnecessary hospital visits for low-acuity emergencies that do not require a trip to the hospital.
Medicare now pays for emergency ambulance services when beneficiaries are transported to hospitals, skilled nursing facilities and dialysis centers. Most beneficiaries who call 911 with a medical emergency are taken to a hospital emergency department. Under the ET3 model, Medicare will reimburse for transport to an urgent care clinic or primary care office, or for providing care in place or using telehealth.
Read more about the ET3 model here.
Read the summary post in Hospital CFO Report here.
The post CMS Delays New Payment Model for Emergency Care Due To Covid-19 appeared first on The Coding Network.
Beginning July 2019, oncologists who are part of the Center for Medicare & Medicaid Services’ (CMS) voluntary Oncology Care Model (OCM) who haven’t achieved a performance-based payment (PBP) will be switched from a 1-sided risk model to a 2-sided risk model. According to an Avalere study, half of those being switched will lose money. Avalere advises […]
The post Oncologists May Lose Money Under OCM Model appeared first on AAPC Knowledge Center.
The Patient Driven Pay Model (PDPM) will change the Skilled Nursing Facility (SNF) Prospective Payment System’s (PPS) method of classifying SNF patients in a Medicare-covered Part A stay Oct. 1. The Centers for Medicare & Medicaid Services (CMS) provide a number of resources on their web site. Patient Driven Pay Model According to the Centers […]
The post Patient Driven Payment Model SNF Resources Available from CMS appeared first on AAPC Knowledge Center.
Medicare’s Part D prescription drug model changes 2020, and it’s going to affect medical coders. The current reimbursement and payment model system for Part D creates incentives for Part D plans to push patients to the “catastrophic phase” of the plan. Once the patient reaches the “donut hole, Medicare is responsible for 80 percent if […]
The post Medicare’s New Part D Prescription Drug Model Changes 2020 appeared first on AAPC Knowledge Center.
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