Thomas Masterson

The Association of Healthcare Value Analysis Professionals (AHVAP) celebrates Elizabeth Eisenberg, MSN, RN, CVAHP from Scripps Health for commitment to excellence in the specialty of healthcare value analysis! Liz has signified this commitment by signing the official Association of Healthcare Value Analysis Professionals (AHVAP) healthcare value analysis pledge. To learn more about the Association of Healthcare Value Analysis Professionals (AHVAP) Commitment pledge: https://lnkd.in/gqEWPBue. #AHVAP #valuebasedcare #excellenceincare #valueanalysis

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New study in #HSR from Yevgeniy Feyman PhD et al  measure specialty provider networks in Medicare Advantage (MA) and examine associations with market factors. WHAT IS KNOWN There is limited evidence on the relationship between MA network breadth among specialists and plan or market factors. WHAT THIS STUDY ADDS Using a recently developed algorithm for measuring the restrictiveness of primary care providers, this study measures the network restrictiveness of nine high-prescribing specialties among MA contracts. CONCLUSION Findings suggest that rural beneficiaries may face disproportionately reduced access in these networks and that efforts to improve access should vary by specialty. FULL ARTICLE: https://lnkd.in/gnn6Uwmk Wiley AcademyHealth #HSR 

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By automatically capturing patient care summaries directly to the EHR, Dragon Medical One is the speech recognition solution that fits your needs without fighting your workflow. Learn more at https://lnkd.in/e86xfcb7

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Most viewed in the last 7 days from JAMA Health Forum: This JAMA Forum discusses the current data collection mechanisms used for Medicare and proposes ways to improve nationwide data collection efforts for Medicaid. https://ja.ma/4dJuqzJ

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Are your MIPS scores not looking good? Do you practice in FL, GA, SC? Even if your don’t before you take an additional Medicare Reimbursment hit (that is in additional to the 5th consecutive physician pay cut in the setting of record inflation) consider checking out the 2024 MIPS Extreme and Uncontrollable Circumstances Exception Application. Between the Change Health Care Cyberattack, a tropical storm early this year causing record flooding in my area and then a Hurricane causing more than a week of power outages it’s impressive if anyone in my area had amazing MIPS scores. It has been a year of considerable challenges. Check out the link below if you are in Tx, FL, GA, NC, SC, or TN as some counties are eligible https://lnkd.in/eJiH7g7z https://lnkd.in/eHyp8qh7

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Introduction of Medicaid APM options for federally qualified health center (FQHCs) was associated with modest, statistically significant increases in quality concentrated among FQHCs with APM models that explicitly incentivized quality. https://ja.ma/4daDw8H

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Starting April 1, 2025, Rural Health Clinics (RHCs) can include CPT Category II codes on Medicare claims. This advancement enhances quality reporting and aligns with value-based care initiatives, as these codes offer detailed insights into patient care. Previously, such submissions led to claim rejections; now, they aim to improve reporting accuracy without altering payment policies. Integrating these codes into the revenue cycle offers several benefits: 1. Accelerated Claims Processing: Detailed documentation reduces the need for additional payer audits, leading to quicker payments and less administrative burden. 2. Improved Quality Metrics: Tracking performance in areas like diabetes management aligns with programs such as Medicare’s Quality Payment Program, potentially resulting in higher reimbursements or bonuses. 3. Error Reduction: Precise coding minimizes errors in claims submissions, decreasing rework and payment delays. 4. Enhanced Negotiation Leverage: Demonstrating high-quality care through data enables better terms with private insurers, leading to higher payment rates or inclusion in premium networks. 5. Alignment with Value-Based Care: Participation in value-based contracts, where outcomes and quality metrics drive revenue, can unlock shared savings and incentive payments. While CPT Category II codes themselves are not reimbursable, their strategic use supports faster payments, fewer denials, and operational efficiency, positively impacting cash flow and the revenue cycle. #Medicare2025 #RuralHealthCare #CPTCodes #QualityReporting #HealthcareUpdates #ValueBasedCare #HealthTech #RHCUpdates #MedicalCoding #HealthPolicy #RevenueCycle #HealthcareInnovation #PatientCareQuality #HealthCareReform https://lnkd.in/etXFK3UG

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➡️ Whether you’ve determined now is the time for you to begin the process toward FACHE or you’re still deciding, the next stop on your journey is our FACHE Overview Webinar. This webinar is free for you to attend but it requires registration. Learn more and register here: https://bit.ly/4fVBYRC

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Mark Your Calendar: December 17th! Join me at 10:00 AM PST | 1:00 PM EST for the Medicare Quarterly Updates Webinar - 4th Quarter hosted by McVey Seminars. Stay informed with the latest Medicare updates! Register today: https://lnkd.in/gmgzbjSg Let’s navigate these updates together! #McVeySeminars #TerryTuesday

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Proof of Purpose; PDPs kept afloat Good for Manufacturers, too? The intricacies of IRA Part D benefit redesign dramatically reshape the OOP for millions of beneficiaries, reducing financial toxicity and raising utilization (I will post to past non adherence figures in comments) Unlike MA PDPs, freestanding PDPs can’t shuttle money over from the medical benefit to moderate premium increases, so some speculated that PDPs would fail. I commented several times that given this administrations view of the private market exemplified by MA that was highly unlikely. And after all PDPs are holding up half the benefit. CMS moves forward. “CMS is also announcing a voluntary demonstration program for standalone prescription drug plans (PDPs). The Part D Premium Stabilization Demonstration is designed to test whether additional policy changes stabilize year-over-year changes in premiums for participating standalone PDPs, leading to more predictable options for beneficiaries during the initial implementation of the IRA’s) benefit improvements, creating more gradual enrollment changes… Under the voluntary demonstration, there will be a reduction in the base beneficiary premium of $15 for all participating PDPs, combined with a year-over-year plan premium increase limit of $35 and narrowed risk corridors..” Thanks Tom Thoughts on implications, such as spillover from reducing headwinds, moderating adoption of narrower formularies and networks? If so possible plus for Phrma —not to mention if it slows down MA train with attendant Part B drug prior auths. #PartD #PDPs

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The AHA has commented on the CMS FY 2025 IPPS proposed rule! 📅 On June 5, the AHA expressed support for provisions aiding low-volume and Medicare-dependent hospitals and some quality-related proposals. However, they raised concerns about the proposed 2.6% net payment update, citing financial challenges hospitals face. AHA urged CMS to make a one-time retrospective adjustment for the FY 2022 market basket forecast and highlighted issues with transparency in disproportionate share hospital payment calculations and CMS' estimates of uninsured individuals. They also recommended against adopting new structural measures and increasing required electronic clinical quality measures. https://loom.ly/aA0SUZA #Healthcare #AHA #CMS #IPPS2025

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Missed our webinar about the hype surrounding AI and outpatient infusion coding? Watch this snippet from the event to see how having an automated solution can simplify your coding so that you aren't leaving revenue on the table.

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We need comprehensive health care reform. Health care reform which is patient centric and not insurance centric.

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The Psoriatic March: PsA before PsO https://buff.ly/3CQxT2s

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🌟 Whether you’ve determined now is the time for you to begin the process toward FACHE or you’re still deciding, the next stop on your journey is our FACHE Overview Webinar. This webinar is free for you to attend but it requires registration. Learn more and save your place here: https://bit.ly/3MkxxT8

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What’s next for Medicare physician payments? Dr. Andrea Brault breaks it down with Tech Target and explores the implications for #EmergencyMedicine https://lnkd.in/g_jtiErW

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