CVS Health announced Sunday that it agreed to buy Aetna for a whopping $69 billion. The deal would be considered one of the largest transactions of the year, combining the drugstore giant and one of the biggest health insurers in…
January 1, 2017-December 31, 2017 | Performance period for 2019 payment (can report data for any 90-day period this year) March 31, 2017 | First APM snapshot; (also June 30 and Aug. 31) April 1–June 30, 2017 | Registration period for submitting data…
Blue Cross Blue Shield just announced that they’re pulling out of 85 counties, over half of the counties in Georgia including Chatham county. This provider is the largest health insurer in the state of Georgia. The decision stems from…
If there is one universal given in healthcare today, it’s the complexity and fear of the unknown of the Quality Payment Program (QPP), or MACRA, whichever title you prefer. From provider feedback, we have crafted an actionable approach to allow…
Transitional Care Management (TCM) bolsters the involvement of primary care physicians in the coordination of post-discharge care to reduce readmission. Patients with moderately complex diagnoses are eligible to receive TCM services during a 30-day window after their discharge from an…
The 2,171-page final rule contains several differences that crosswalk existing PQRS measures to new finalized metrics. The simplest way to ensure your PQRS-to-MIPS transition goes smoothly is to search each quality metric and data submission method here. Several important tables…
Hierarchical Condition Category (HCC) coding is a payment model implemented by CMS in 2003 to assign a Risk Adjustment Factor (RAF) to individuals with chronic illnesses based upon a combination of their health conditions and demographic circumstances. HCCs are split…
The Centers for Medicare & Medicaid Services (CMS) proposed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) in late April, 2016. This release announced a fundamental overhaul of physician payment methodologies from a model reimbursing each individual service…
As The Department of Justice (DOJ) recently filed Antitrust lawsuits against both the Connecticut-based Aetna and Indianapolis-based Anthem “Mega-Mergers,” the DOJ is suggests a February start date to the trial. With Aetna aiming to complete a $37 billion acquisition of Humana…
Developments continue regarding the proposed mergers between Anthem/Cigna and Aetna/Humana. Yesterday, the Justice Department reported they will likely file lawsuits this month to halt both proposed mergers. If the Justice Department does take action, it may significantly delay any merger. …