Reid Kiser’s Post

Update from CMMI on the efforts to have all traditional Medicare beneficiaries in accountable care plans by 2030: CMS’s 2030 accountable care goals will be achieved through the alignment of Innovation Center models and changes to, and growth in, Medicare programs and payment systems. Recent proposed changes to the Medicare Shared Savings Program and the Medicare Physician Fee Schedule demonstrate how CMS intends to scale Innovation Center findings in the Medicare program. However, achieving the goal of 100 percent of traditional Medicare beneficiaries in an accountable care relationship will require continued collaboration with providers and beneficiaries. Taking steps to translate lessons learned and improve the sustainability of value-based and accountable care can improve and strengthen traditional Medicare for all beneficiaries. https://lnkd.in/efFdhTas

It continues to be encouraging to see the commitment that the Centers for Medicare & Medicaid Services has toward expanding and enriching pathways for more #Medicare patients to receive care in an accountable relationship. This Health Affairs Forefront article authored by CMMI and CMS leadership summarizes those efforts and highlights the proposed change in the 2025 Physician Fee Schedule introducing Advanced Primary Care Management billing codes to help support primary care practices that are delivering more robust care management and advanced primary care services to Medicare patients. As with RPM and CCM codes I expect that a small subset of practices will engage in these billing codes initially, but for those who are well setup to do so it provides a more sustainable funding mechanism to bring more dollars into Primary Care and help to create a hybrid financial model between FFS and Full Capitation. I’m curious what others think about these proposed codes https://lnkd.in/eurGqvPW

The recently released Health Care Transformation Task Force and National Association of ACOs resource on Reimagining Beneficiary Engagement in Accountable Care Models was featured in Medical Economics and Xtelligent Healthcare ! This resource outlines policy recommendations for the Centers for Medicare & Medicaid Services aimed at strengthening patient engagement in ACO governance, care delivery redesign, and individual care planning, with a particular focus on Medicare Accountable Care Organizations (ACOs).      “Effective patient engagement is paramount to the success of ACOs,” said Jeff Micklos, Task Force Executive Director. “These recommendations strengthen Medicare policies to ensure that beneficiaries are fully aware of and can benefit from these innovative care models.”    Check out the articles here:   👉 https://lnkd.in/dQ6yGefT  👉 https://lnkd.in/dDneAnrU 

New Centers for Medicare & Medicaid Services proposals are set to impact the Medicare Shared Savings Program and the transition from MIPS to MVPs for 2025. For ACOs and clinicians participating in the QPP, understanding these updates is vital to the improvement of patient care and financial outcomes. Discover the importance of these changes for ACOs and MIPS/MVP participants and learn how MRO can assist you in navigating the new regulations: https://okt.to/I7zKBn #qualityreporting #CMSupdates #MSSPACOs #QPPreporting #healthcare #CQMs #eCQM #ACOs #MIPs

The recently released Health Care Transformation Task Force and National Association of ACOs resource on Reimagining Beneficiary Engagement in Accountable Care Models was featured in Medical Economics and Xtelligent Healthcare ! This resource outlines policy recommendations for the Centers for Medicare & Medicaid Services to strengthen patient engagement in ACO governance, care delivery redesign, and individual care planning, focusing on Medicare Accountable Care Organizations (ACOs).      “Effective patient engagement is paramount to the success of ACOs,” said Jeff Micklos, Task Force Executive Director. “These recommendations strengthen Medicare policies to ensure that beneficiaries are fully aware of and can benefit from these innovative care models.”    Check out the articles here:   👉 https://lnkd.in/dQ6yGefT  👉 https://lnkd.in/dDneAnrU

CMS Interoperability and Prior Authorization Final Rule Synopsis The Centers for Medicare & Medicaid Services (CMS) changed its prior authorization rules to simplify and digitize the process, and to reduce the burden on each of the three legs in the healthcare delivery tripod: patients, providers, and payers. In particular, CMS aims to reduce administration, simplify and accelerate the process, and introduce standardization across payers. It is critically important for providers and especially payers to get ahead of these changes by assessing processes and the technology necessary to support the rules change and ensure compliance. #priorauthorizations #healthcare #healthcareprocesses #healthcareadministration #healthcarecompliance

Prior Authorization has been in the news lately... and that's not even counting the latest changes made by CMS. We summarize them here. And of course, we can help you navigate through these latest updates.

The 2024 CMS Priori Authorization rule was passed to reduce burden for providers, members and Payers for data exchange and approval process, however work must be done for payers and providers. Some provisions and policy adoption are required (January 2026) and data exchange integration by January 2027. This article provides an overview of the policy, provisions and requirements, as well as some guidance to build your strategy to meet the requirements. https://lnkd.in/gp32MjUN

As healthcare evolves, staying ahead of regulatory changes is essential. The latest update from the Centers for Medicare & Medicaid Services (CMS) on the Interoperability and Prior Authorization Final Rule (CMS-0057-F) aims to simplify, digitize, and streamline the prior authorization process for Medicare, Medicaid, CHIP, and other qualified health plans. With tighter timelines and new requirements for API integration, public metrics, and standardized denial rationales, healthcare providers and payers face an important transition by 2026-2027. Navigating these changes demands a proactive approach. Assessing current workflows, identifying technology gaps, and building a compliant infrastructure are critical steps for efficient implementation. Through clear planning and strategic investment, organizations can reduce administrative burdens, enhance data exchange, and improve patient care coordination. For any payers or providers impacted by these rules, it’s time to prepare. Begin developing the necessary processes and systems to meet these standards and ensure a seamless transition into the future of healthcare compliance. #HealthcareTech #CMSUpdates #HealthcareCompliance

Seeing the impact of data gaps in Medicare Advantage through my work as a healthcare provider has been eye-opening. Many patients I encounter are affected by these gaps, which significantly impact their access to quality care and the overall efficiency of our healthcare system. Filling these data gaps is crucial. The Centers for Medicare and Medicaid Services (CMS) must address these gaps to ensure that Medicare Advantage plans are meeting the needs of all beneficiaries, especially those in vulnerable populations. Without comprehensive data, it’s challenging to assess whether patients are receiving appropriate care, and disparities in healthcare outcomes may go unaddressed. This issue isn’t just about numbers; it’s about ensuring that every patient receives the care they deserve. In my practice, I’ve noticed that when we have access to complete and accurate data, we can make better-informed decisions that directly improve patient outcomes. The ability to track and analyze healthcare trends allows us to identify areas where care might be lacking and to implement strategies that enhance the quality of care provided. Addressing these data gaps also helps ensure that resources are allocated efficiently and that healthcare providers can focus on delivering care where it’s most needed. It’s an essential step towards achieving a more equitable and effective healthcare system. As we continue to seek improvements in healthcare delivery, prioritizing the closure of these data gaps should be a central part of the conversation. By ensuring that CMS fills these gaps, we can take significant steps toward a healthcare system that truly serves all patients. Read More below: https://buff.ly/3WMjiwy #doctors #hospitals #healthcare #primarycare