Reimbursement

CMS has paid over $2.5 billion to Part A hospitals and more than $717 million to Part B physicians, suppliers and others.

In traditional FFS, clinicians see one patient, but in value-based care, the provider is responsible for a population of patients and needs to know where else they have received care, which brings in the necessity for interoperability, says Dr. Harm Scherpbier, HealthShare Exchange CMIO.  

The decision comes after CMS lost two court cases, but the agency says it reserves the right to appeal.

Change is needed on Capitol Hill, which is why the Digital Therapeutics Alliance summit was held in D.C., says Andy Molnar, president of the group.  

CMS has been ordered to redetermine the star ratings, which Elevance says should be higher.

The current HHS formula costs hospitals more than a billion dollars each year, says AHA.

"Today's decision is a victory for Tribal self-determination and Tribal sovereignty," says Mark Macarro.

Providers bypass the manual process for medical record requests through ChartSwap's automated system, says president Nate Kelly.

The ruling could have industry-wide implications for other MA plans seeking to raise their star ratings and bonuses.

MedeAnalytics and HSBlox are able to work out friction points, develop contracts, pay providers and use analytics to measure performance for value-based care, says David Wolf, MedeAnalytics AVP, and Lynn Carroll, HSBlox COO.