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FY 2019 IPPS Proposed Rule Overview

The Centers for Medicare and Medicaid (CMS) has published the proposed FY 2019 Hospital Inpatient Prospective Payment System (IPPS). Following is a summary of the major provisions of the proposed rule as well as details on the changes to MS-DRG payments rates from FY 2018 to 2019. 

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Topic: Provider Compensation
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Document Type: Articles/Whitepapers


Thumbnail image for Where the Money Is: New Cardiac Interventions Today Article

Where the Money Is: New Cardiac Interventions Today Article

Is your heart program leaving money on the table? Improve the financial health of your heart program by focusing on these six areas as outlined in a new Cardiac Interventions Today article by Larry Sobal.

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Topic: Cardiovascular Service Line
Tagged: Advanced Practicing Providers (APPs), CHF Clinics, Cath Lab Management
Document Type: Articles/Whitepapers,


Thumbnail image for PCI Within the Context of the Episode Payment Model

PCI Within the Context of the Episode Payment Model

The latest issue of Cardiac Interventions Today magazine has just been published and features an article on cardiac EPMs by MedAxiom Consulting’s Joel Sauer. As we wait for CMS to announce if it will cancel the mandatory episode payment model for programs for acute myocardial and coronary artery bypass surgery (the public comment period ended on 10/16/17), this article provides important details on cardiac episode payment models and implications for percutaneous coronary intervention.

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Topic: Financial Management
Tagged: EPMs
Document Type: Articles/Whitepapers


Thumbnail image for You are Leaving Money on the Table by Admitting Low-Risk PCIs

You are Leaving Money on the Table by Admitting Low-Risk PCIs

You are Leaving Money on the Table by Admitting Low-Risk PCIs

In the October issue of Cath Lab Digest, Larry Sobal, MedAxiom Executive Vice President, and Nicole Knight, Director, Revenue Cycle Solutions, MedAxiom Consulting, share their views regarding what has become a contentious and incomplete understanding of what hospitals believe they are being reimbursed versus the costs they and their patients are incurring for the CMS patient undergoing a PCI procedure.

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Topic: Financial Management
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Document Type: Articles/Whitepapers


Summary of the American Health Care Act Bill

On May 4th, the American Health Care Act (AHCA) passed the House of Representatives (217-213), which now goes to the Senate. Major provisions of the AHCA bill include:

  • Reduce government spending, mostly by cutting subsidies currently included in the Affordable Care Act (ACA)
  • Reduce the number of people that qualify for Medicaid
  • Repeal the individual and employer mandates requiring health coverage or face a tax penalty
  • Allow states to apply for waivers to change the mandate for covering pre-existing conditions and to change the definition of the essential benefits mandated in insurance coverage
  • Add funding over five years to “high-risk” pools meant to offset the higher insurance costs of covering those with pre-existing conditions
  • Change Medicaid funding to include federal block grants to States
  • Restore Medicaid Disproportionate Share Hospital Payments in 2018 or 2020, depending if the State expanded Medicaid under the ACA
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Topic: Healthcare Policy
Tagged: American Health Care Act
Document Type: Articles/Whitepapers


MIPS Participation Status Letter

The Centers for Medicare & Medicaid Services is reviewing claims and letting practices know which clinicians need to take part in MIPS, the Merit-based Incentive Payment System. MIPS is an important part of the new Quality Payment Program.

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Topic: Healthcare Policy
Tagged: Quality Management
Document Type: Articles/Whitepapers


QPP UPDATE: How the Scoring for Various Elements of the MIPS Categories will be Handled

Among the new items recently released from the Centers for Medicare and Medicaid (CMS) on the Merit-based Incentive Payment System (MIPS), there are some details on Advancing Care Information (ACI) that will impact many in the MedAxiom community. 

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Topic: Healthcare Policy
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Document Type: Articles/Whitepapers


Thumbnail image for Cardiac Bundles — What Are the Implications?

Cardiac Bundles — What Are the Implications?

  January 2, 2017

However audacious the concept of a 90-day bundle may seem to some, a bundled episode of care may well be the answer for some systems looking to be more competitive in the current healthcare landscape. Gary Clifton, Vice President of Terumo Business Edge, interviews Ryan Graver, President of MedAxiom Ventures, to discuss some of the challenges and opportunities that will be facing many cardiac programs, but also look to the future, and how embracing and possibly expanding the mandatory bundled concept could be well worth considering.

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Topic: Healthcare Policy
Tagged: Affordable Care Act, Cardiac Rehab
Document Type: Articles/Whitepapers


Thumbnail image for Episode Payment Models &  Cardiac Rehabilitation Incentive Payment:  Final Rule Overview

Episode Payment Models & Cardiac Rehabilitation Incentive Payment: Final Rule Overview

This document is the result of detailed analysis of the 1,600+ page rule; the goal is to provide our members with an understandable summary to guide you through the complexities of this rule, and help you learn how to benefit from it whether in a chosen MSA or not.

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Topic: Healthcare Policy
Tagged: Cardiac Rehab
Document Type: Articles/Whitepapers