Sharon West’s Post

The Centers for Medicare & Medicaid Services (CMS) has finalized its Calendar Year (CY) 2025 Medicare Physician Fee Schedule (PFS) rule, which includes a 2.83% reduction in the payment conversion factor, lowering it to $32.35 from $33.29 in 2024. The rule also strengthens primary care, supports preventive services, and continues telehealth waivers, but it raises significant concerns for healthcare providers. Many doctors face increasing difficulty in navigating the complexities of Medicare reimbursements, with declining payment rates and rising administrative burdens. The National Association of ACOs and the American Academy of Family Physicians have voiced concerns about reduced financial targets, which are putting physician practices at risk and hindering access to care. New quality reporting requirements also necessitate costly investments in technology, but without providing actionable data, making it harder for practices to stay afloat. In this challenging landscape, Monarch MPS can help by streamlining the reimbursement process, ensuring that physicians get the reimbursements they deserve while reducing the administrative burden. Monarch MPS offers services designed to simplify billing, optimize payment collections, and help practices navigate the complexities of Medicare to improve cash flow and patient care. As CMS continues its push for an equitable healthcare system, healthcare providers need efficient solutions to thrive in a changing environment. Monarch MPS is here to help practices adapt and succeed. #Medicare #HealthcareReimbursement #PrimaryCare #Telehealth #HealthEquity #PhysicianFeeSchedule #ACO #MonarchMPS #PhysicianSupport #HealthcareSolutions

Major shifts in Medicare Advantage are taking place, including a crucial component of a new regulation—the extension of the two-midnight benchmark rule to MA plans. Our latest blog, “New Medicare Advantage Rule: Implications for Healthcare Providers and Patients,” unpacks the game-changing rule from the Centers for Medicare & Medicaid Services (CMS). Learn what it means to health systems and hospitals moving forward here: https://hubs.li/Q02Rzdxp0 #RCMblog #revenuecyclemanagement #rcm #HealthcareFinance #MedicareAdvantage #HealthcarePolicy #CMS #CMSUpdates #HealthcareInnovation #revenuecyclemanagementsupport #healthcare #healthcarercm #healthcarelegislation

Providers Are Fed Up With Medicare Advantage More and more health systems are parting ways with big-name Medicare Advantage plans for good reason. Hassles, denying care for inpatient level of care, denying authorization for outpatient scheduled procedures, putting up roadblocks for payment according to the negotiated contract terms, requesting more medical records prepayment to slow down payment, hiring contractors to steal back monies for paid claims one to two years earlier, second-guessing physicians clinical judgment and medical decision making in diagnosing through clinical validation denials, etc. This sums it up well: "Moreover, this trend could lead to even more scrutiny and potential reforms in Medicare Advantage policies. Stakeholders, including policymakers, may need to address the concerns raised by providers to ensure that MA plans can fulfill their promise of comprehensive, accessible care without imposing undue burdens on healthcare systems." I suggest : Moreover, this trend must lead to even more scrutiny and potential reforms in Medicare Advantage policies. Stakeholders, including policymakers, must address the concerns raised by providers to ensure that MA plans can fulfill their promise of comprehensive, accessible care without imposing undue burdens on healthcare systems. Medicare Advantage is leading the innovative use of value-based care — delivering better health outcomes, through better quality care at a better cost for Medicare beneficiaries according to the trade group for Medicare Advantage plans- Better Medicare Alliance. Mission of this organization- More than 33 million beneficiaries have made the choice to enroll in Medicare Advantage. Seniors and people with disabilities deserve quality health care — and we believe Medicare Advantage provides the opportunity for a healthier future. Medicare Advantage Plans provide for a healthier future for their C suites and shareholders through healthy profits and stock dividends paid on the backs of providers and beneficiaries who are denied needed care such as SNF and rehab, services Humana has a tendency to deny or if you are UHC, use AI to determine when to stop paying for inpatient rehab/SNF. #MedicareAdvantage, #Medicaredisadvantage, #profitfirst, #reininginMAplans https://lnkd.in/exujjGN6

New CMS report: The Medicare Shared Savings Program (MSSP) continues to demonstrate its effectiveness in delivering high-quality care while generating significant cost savings. Key highlights from the report: - MSSP generated $1.8B in savings for Medicare in 2022 - 483 ACOs participated, serving 11 million Medicare beneficiaries - 99% of ACOs successfully reported quality measures - 54% of ACOs earned shared savings payments These outcomes reinforce that VBC can drive care quality while improving financial outcomes for the ACOs who participate. Check it out here: https://lnkd.in/dJDNU6-c #Valuebasedcare #healthcareinnovation #ACOs #Medicare

CRS Finding Medicare Fee-For-Service (FFS) Payment System Rules: Schedules and Resources [13 September 2024] https://lnkd.in/gdBsVU5z The Medicare Fee-For-Service (FFS) program pays physicians, hospitals, and other health care facilities based on statutorily established payment systems, most of which are updated annually through regulations. Medicare FFS proposed and final rules follow schedules based on requirements found in statute, regulation, or both. As Medicare FFS payment system proposed and final rules are issued, they impact payments received by health care facilities and providers. Congressional Members and committees may comment, and are often contacted by provider and beneficiary groups. Tracking the status and requirements for specific rules can be onerous, since they have different schedules and web locations. This report contains information on these payment system rules in a quick reference table. Specifically, the table compiles the payment systems, their main portals on the Centers for Medicare & Medicaid Services (CMS) website, the typical rulemaking schedule, statutory and regulatory requirements, and the most recently issued proposed rules, public comments, final rules, and subsequent corrections. The table also includes embedded links to the applicable resources. Not all payment systems include detailed statutory and regulatory requirements, as noted in the table.

We're excited to share that Health Connect Partners (HCP), our Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO), generated more than $137 million in savings to the Center for Medicare and Medicaid Services (CMS) in 2023 —the most ever for any MSSP ACO in a single year. 👏 🌟 MSSP ACOs are groups of providers and care delivery organizations that collaborate to offer coordinated care to people with Medicare, with a goal of keeping beneficiaries healthier while avoiding medical errors and unnecessary services. ▶️ Learn more about how we achieved this milestone through innovative strategies in care coordination and value-based care: http://ms.spr.ly/6049WihrP #HealthForABetterWorld #Medicaid #HealthcareInnovation #ValueBasedCare

🌟 Exciting News in Medicare Policy! 🌟 The Centers for Medicare & Medicaid Services (CMS) has announced significant updates in the Contract Year 2025 Medicare Advantage and Part D Final Rule. These changes focus on enhancing access, promoting competition, and ensuring that Medicare Advantage and Part D plans best serve enrollees' needs. At Abel Personnel, we understand the importance of having the right team in place to navigate complex healthcare regulations. Our expertise in staffing solutions ensures that healthcare organizations can meet these new requirements seamlessly. Looking for enrollment staffing solutions? Reach out to Abel Personnel at 717-561-2222 or visit www.abelpersonnel.com to discover how we can support your needs. Read more about the Contract Year 2025 Medicare Advantage and Part D Final Rule here: https://lnkd.in/e--b3t47 #MedicarePolicy #EnrollmentSolutions #HealthcareStaffing

🎉 2023 Medicare Shared Savings Program Results Are In! Yesterday, the Centers for Medicare & Medicaid Services (CMS) lifted the embargo on the 2023 Medicare Shared Savings Program (MSSP) results—and the news is impressive! Congratulations to all the Accountable Care Organizations (ACOs) that achieved shared savings and contributed to the remarkable $2.1 billion in total savings for CMS. These achievements speak volumes about the power of value-based care, especially at a time when some question its effectiveness. The success of ACOs in the MSSP highlights the transformative impact of population health initiatives, emphasizing that high-quality, cost-effective healthcare is not just possible but achievable. This performance is a testament to the significant benefits of investing in population health. Through collaborative, patient-centered approaches, ACOs are delivering substantial gains for patients, providers, and the healthcare system as a whole. 👏 Cheers to all ACOs who improved quality and earned shared savings in 2023. Here’s to the continued success of value-based care in improving lives and reinvesting back into practices nationwide! #MSSP #ValueBasedCare #SharedSavings #HealthcareTransformation #PopulationHealth #AccountableCare https://lnkd.in/gjXZ6xwV

Medicare Advantage, covering over half of Medicare beneficiaries, is at a crossroads. Hospitals are frustrated with denied payments, insurers struggle with profitability, and CMS tightens regulations. Will benefits be slashed? Can hospitals maintain these plans? How will new rules shape patient care? 👉 Explore the top 10 questions shaping the future of Medicare Advantage and its impact on providers, insurers, and policymakers: https://bit.ly/3VaZy4Q #Healthcare #MedicareAdvantage #InsuranceTrends

More than half of Traditional Medicare enrollees are in an accountable care relationship as of January 2025, according to new data from the Centers for Medicare & Medicaid Services (CMS). The Alliance is encouraged by this progress and looks forward to working with CMS to continue to expand access to value-based care. #ValueBasedCare #AccountableCare #Medicare