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About the Health FFRDC CMS

Details: The Health FFRDC Operator is uniquely qualified and experienced to objectively analyze long-term health system problems, address complex technical questions, and generate creative and cost-effective solutions in strategic areas such as quality of care, new payment …

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› Url: https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAMH/About-Health-FFRDC Go Now

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Health Care Claims Status CMS

Details: Health Care Claims Status. Under HIPAA, HHS adopted standards for electronic transactions, including for health care claim status. A health care claim status transaction is used for: An inquiry from a provider to a health plan to determine the status of a health care claim. A response from the health plan to a provider about the status of a

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› Url: https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/Transactions/HealthCareClaimsStatus Go Now

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Home Health Services Fact Sheet

Details: The beneficiary requires home health services because the beneficiary is or was confined to the home. 2. The beneficiary needs or needed intermittent skilled nursing services (other than solely venipuncture for the purposes of obtaining a blood sample), or physical therapy, or speech-language pathology services. If a

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› Url: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ProviderComplianceTipsforHomeHealthServices-ICN909413.pdf Go Now

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Health Plan Eligibility Benefit Inquiry and Response CMS

Details: Under HIPAA, HHS adopted standards for electronic transactions, including the health plan eligibility benefit inquiry and response. The eligibility/benefit inquiry transaction is used to obtain information about a benefit plan for an enrollee, including information on eligibility and coverage under the health plan. This inquiry can be sent from a health care provider to a health plan, or from

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› Url: https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/Transactions/HealthPlanEligibilityBenefitInquiryandResponse Go Now

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Health Care Innovation Awards: New York CMS Innovation

Details: Health coaching and improved access to primary care is expected to result in lower ER utilization, reduced hospital admissions, and improved health with estimated savings of approximately $6.1 million. Over the three year period, University Emergency Medical Service's program will train an estimated 13 health

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› Url: https://innovation.cms.gov/innovation-models/health-care-innovation-awards/new-york Go Now

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New York Fully Integrated Duals Advantage (FIDA

Details: Under FIDA, individuals will have access to all home health services covered by Medicare and Medicaid. Medicare home health services include intermittent skilled nursing care, physical therapy, continuing occupational therapy, speech–language pathology, home health aide services, and medical social services.

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› Url: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/Downloads/NYHomeHealthProviderFAQ.pdf Go Now

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Centers for Medicare & Medicaid Services Serving …

Details: health care hospital and clinics, their own health, and the health of others. Patients enrolled in Medicaid, the Children’s Health Insurance Program, or Medicare enable Indian health hospitals and clinics to bill these programs for services provided. These programs

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› Url: https://www.cms.gov/Outreach-and-Education/American-Indian-Alaska-Native/AIAN/Outreach-and-Education/pdf/brochure_OE-booklet03.pdf Go Now

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MAC Website List CMS

Details: Find your Medicare Administrative Contractor's (MAC’s) website by selecting your place of business or MAC's name. Also included at the end of the “MAC Name” list are links to specialty contractors you may also interact with as a Medicare provider or supplier. Providers who submit claims not based on their place of business can use the MAC name list.

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› Url: https://www.cms.gov/Medicare/Medicare-Contracting/FFSProvCustSvcGen/MAC-Website-List Go Now

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New to the Marketplace marketplace.cms.gov

Details: These resources may help you as you assist people who are thinking about getting coverage through the Marketplace. The publications provide information on enrollment, the appeals process, income taxes, and how Marketplace coverage works. There are also promotional materials for college students and people who speak languages other than English.

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› Url: https://marketplace.cms.gov/new-marketplace Go Now

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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS …

Details: DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES . 7 . State Survey Agency Directory – January 2017. State Last Name First Name Address Work Number Fax Number E-Mail Address Colorado . Johnson-Hufford Kara Health Facility Quality Branch Chief (Same as above) 303-692-2808 303-753-6214

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› Url: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/State_Agency_Contacts.pdf Go Now

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What’s a Health Savings Account

Details: A Health Savings Account (HSA) is a type of personal savings account you can set up to pay certain health care costs. An HSA allows you to put money away and withdraw tax free, as long as you use it for qualified medical expenses. You’re eligible to contribute to an HSA when you’re covered by certain high deductible health

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› Url: https://marketplace.cms.gov/outreach-and-education/health-savings-account.pdf Go Now

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CMS Proposed Rule to Increase Americans’ Access to Health

Details: The Centers for Medicare & Medicaid Services (CMS) today proposed a series of provisions to follow through on President Biden’s commitment to build on the Affordable Care Act (ACA), expand health coverage access and advance health equity. These provisions are the third installment of the payment notice for 2022. The proposed rule includes a variety of provisions to protect and expand

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› Url: https://www.cms.gov/newsroom/press-releases/cms-proposed-rule-increase-americans-access-health-coverage-2022 Go Now

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CMS Proposes Physician Payment Rule to Improve Health

Details: CMS Seeks Feedback on Health Equity Data Collection. CMS is committed to addressing the significant and persistent inequities in health outcomes in the U.S. by improving data collection to better measure and analyze disparities across programs and policies. In the proposed PFS rule, CMS is soliciting feedback on the collection of data, and on

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› Url: https://www.cms.gov/newsroom/press-releases/cms-proposes-physician-payment-rule-improve-health-equity-patient-access Go Now

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Using Z Codes: The Social Determinants of Health (SDOH

Details: service organizations, providers, health plans, and consumer/patient advisory boards to identify unmet needs. • A can be used to identify opportunities for advancing health equity. Disparities Impact Statement • Identify individuals’ social risk factors and unmet needs. • Inform health care and services, follow-up, and discharge

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› Url: https://www.cms.gov/files/document/zcodes-infographic.pdf Go Now

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Home Health Star Ratings CMS

Details: Patient Survey Stars & Home Health CAHPS: [email protected] or call 1-866-354-0985. Quality of Patient Care Star Ratings: [email protected] All requests for formal review of Quality of Patient Care Star Ratings including requests to suppress data: [email protected]

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› Url: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/HHQIHomeHealthStarRatings Go Now

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Quality Measures CMS

Details: Quality health care is a high priority for the President, the Department of Health and Human Services (HHS), and the Centers for Medicare & Medicaid Services (CMS). CMS implements quality initiatives to assure quality health care for Medicare Beneficiaries through accountability and public disclosure. CMS uses quality measures in its various quality initiatives that include quality improvement

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› Url: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures Go Now

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CMS Proposes Calendar Year 2022 Home Health Prospective

Details: Today, the Centers for Medicare & Medicaid Services (CMS) took action to improve home health care for older adults and people with disabilities through a proposed rule that would accelerate the shift from paying for Medicare home health services based on volume to a system that pays for value and quality by proposing a nationwide expansion of the Home Health Value-Based Purchasing (HHVBP) Model.

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› Url: https://www.cms.gov/newsroom/fact-sheets/cms-proposes-calendar-year-2022-home-health-prospective-payment-system-rate-update Go Now

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Federally Qualified Health Centers (FQHC) Center CMS

Details: Claims for G0071 will be paid at the CY 2020 rate of $13.53 and later reprocessed with the new rate of $24.76. FQHCs can bill for visiting nursing services furnished by an RN or LPN to homebound individuals under a written plan of treatment in areas with a shortage of home health agencies (HHAs). Effective March 1, 2020 and for the duration of

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› Url: https://www.cms.gov/Center/Provider-Type/Federally-Qualified-Health-Centers-FQHC-Center Go Now

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CMS Extends Open Enrollment Period and Launches

Details: 2 days ago · “Health care is a basic human right, and the Biden-Harris Administration is committed to making health coverage more accessible than ever. With the Affordable Care Act and the American Rescue Plan, the President has brought affordable health coverage to millions—many of whom now have insurance for the first time,” said CMS Administrator

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› Url: https://www.cms.gov/newsroom/press-releases/cms-extends-open-enrollment-period-and-launches-initiatives-expand-health-coverage-access-nationwide Go Now

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Health Care Claim or Equivalent Encounter Information CMS

Details: The health care claims or equivalent encounter information transaction includes either of the following: A request to obtain payment, and the necessary accompanying information from a health care provider to a health plan, for health care. In January 2009, HHS adopted Version 5010 of the ASC X12N 837 for health care claim or equivalent

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› Url: https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/Transactions/HealthCareClaimorEquivalentEncounterInformation Go Now

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Home Health QRP Spotlight and Announcements CMS

Details: Please visit Care Compare or Home Health Compare to view the new and updated quality data which for this quarter will contain the annual refresh of the claims-based measures (Please note that the October 2020 refresh of the Home Health Compare/Care Compare Sites is the last scheduled refresh of this data until the January 2022 refresh. For

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› Url: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Spotlight-and-Announcements Go Now

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Health Plan Management System Login Page

Details: Helping plans navigate the Medicare Advantage and Part D programs HPMS is a full service website where health and drug plans, plan consultants, third party vendors, and pharmaceutical manufacturers can work with CMS to fulfill the plan enrollment and compliance requirements of the Medicare Advantage (MA) and Prescription Drug (Part D) programs.

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› Url: https://hpms.cms.gov/app/login.aspx?ReturnUrl=%2fapp%2fhome.aspx Go Now

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Home Health Agencies CMS

Details: The existing CoPs are the minimum health and safety standards that home health agencies (HHAs) must comply with in order to qualify for reimbursement under the Medicare program. Related Links CONDITIONS OF PARTICIPATION: HOME HEALTH AGENCIES

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› Url: https://www.cms.gov/Regulations-and-Guidance/Legislation/CFCsAndCoPs/homehealth Go Now

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Home Health PPS CMS

Details: Home Health PPS. The Balanced Budget Act (BBA) of 1997, as amended by the Omnibus Consolidated and Emergency Supplemental Appropriations Act (OCESAA) of 1999, called for the development and implementation of a prospective payment system (PPS) for Medicare home health services. The BBA of 1997 put in place the interim payment system (IPS) until

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› Url: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS Go Now

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CMS Data Shows Vulnerable Americans Forgoing Mental Health

Details: The data show that, from March through October 2020, beneficiaries have foregone millions of primary, preventive, and mental health care visits due to the COVID-19 PHE, compared to the same time period in 2019. Although utilization rates for some treatments have rebounded to pre-pandemic levels, mental health services show the slowest rebound.

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› Url: https://www.cms.gov/newsroom/press-releases/cms-data-shows-vulnerable-americans-forgoing-mental-health-care-during-covid-19-pandemic Go Now

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COVID-19 Emergency Declaration Blanket Waivers for Health

Details: Health Care Providers . The Administration is taking aggressive actions and exercising regulatory flexibltiiies to help healthcare providers contain the spread of 2019 Novel Coronavirus Disease (COVID -19). CMS is empowered to take proactive steps through 1135 waivers as well as, where applicable, authority

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› Url: https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf Go Now

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Prepare for a Behavioral Health Appointment CMS

Details: These tools can help you prepare for your behavioral health appointment. Each one includes a copy you can download and take with you to your appointment. Your Concerns The sample questions below can help prepare you for your first appointment with your behavioral health provider. There are lots of other questions you can ask to help determine what you want to cover, so this doesn't represent

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› Url: https://www.cms.gov/outreach-education/american-indianalaska-native/behavioral-health/prepare-behavioral-health-appointment Go Now

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TrailBlazer Health Enterprises, LLC CMS

Details: TrailBlazer Health Enterprises, LLC Organization Description: Part A bills and services, hospital care, skilled nursing care, and fraud. Regions: Region Six - Dallas: Covered States and Territories: New Mexico : Address: 8330 LBJ Freeway, Executive Center III Dallas TX 75243

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› Url: https://www.cms.gov/contacts/trailblazer-health-enterprises-llc/contractor-medical-director-cmd/1552696 Go Now

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Chronic Care Healthcare Resources CMS

Details: Connected Care: The Chronic Care Management Resource. The Connected Care initiative provides resources and tools that can help health care professionals learn how to implement chronic care management (CCM) and receive payment for providing these services.. Chronic care management is care coordination services done outside of the regular office visit for patients with multiple (two or more

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› Url: https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/ccm/hcpresources Go Now

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Home Health Quality Reporting Program Help Desks CMS

Details: Home Health CAHPS: [email protected]; Phone: 1-866-354-0985. Questions related to the Home Health CAHPS Survey or the Patient Survey Star Ratings. Home Health Value-Based Purchasing (HHVBP) Help Desk: [email protected]

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Home Health Prospective Payment System (HH PPS) Limited

Details: The “Home Health Claims – OASIS” Limited Data Set (LDS) file contains information on the utilization of the Medicare Home Health (HH) benefit. The file is constructed so that each observation represents a particular home health period in a given year.

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› Url: https://www.cms.gov/Research-Statistics-Data-and-Systems/Files-for-Order/LimitedDataSets/Home_Health_PPS_LDS Go Now

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Glossary of Health Coverage and Medical Terms

Details: health care facility licensed, certified or accredited as required by state law. Reconstructive Surgery . Surgery and follow-up treatment needed to correct or improve a part of the body because of birth defects, accidents, injuries or medical conditions. Rehabilitation Services .

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Welcome to the Medicare Secondary Payer (MSP) Overview …

Details: A Group Health Plan is health coverage sponsored by an employer or employee organization (such as a union) for a group of employees, and possibly for dependents and retirees as well. The term GHP includes self-insured plans, plans of government entities (Federal, State, …

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› Url: https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of-Benefits-and-Recovery-Overview/Medicare-Secondary-Payer/Downloads/MSP-Overview.pdf Go Now

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HIPAA Basics for Providers: Privacy, Security & Breach

Details: health care professionals, page 4 • Added Information – Sharing patient information with family members and others, page 4 • Added Information – Incidental disclosures, page 5 • Added Information – Protecting and securing health information when using a mobile device, page 5.

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› Url: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/HIPAAPrivacyandSecurity.pdf Go Now

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MLN Telehealth Services CMS

Details: Rural Health Professional Shortage Area (HPSA) in a rural census tract The Health Resources and Services Administration (HRSA) decides HPSAs and the Census Bureau decides MSAs. Find potential Medicare telehealth originating site payment eligibility at HRSA’s .

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› Url: https://go.cms.gov/mln-telehealth-services-icn901705 Go Now

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Health Reimbursement Arrangement (HRA)

Details: Health Reimbursement Arrangement (HRA) Monday, October 5, 2020 . Page 14 of 21 Slide 14 of 21 - HRA Reporting Requirements Termination Dates Slide notes Assume we have a beneficiary who is age 66. Medicare is the secondary payer under the Working Aged provisions. The beneficiary enrolls in his employer’s HRA effective January 1, 2011.

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Health Outcomes Survey (HOS) CMS

Details: The Medicare Health Outcomes Survey (HOS) limited data sets (LDS) are comprised of the entire national sample for a given annual survey or 2-year cohort (including both respondents and non-respondents), and contain all of the HOS survey items. Plan contract numbers have been blinded and certain plan level fields removed to prevent identification of individual health plans.

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› Url: https://www.cms.gov/Research-Statistics-Data-and-Systems/Files-for-Order/LimitedDataSets/HOS Go Now

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Home Health Process Measures Table

Details: Home Health Process Measures OASIS-D (effective 01/01/201 9) Centers for Medicare & Medicaid Services Page 1 of 4 . Home Health Quality Measures – Process . Notes: 1. Risk Adjustment: Process measures are not risk adjusted to compensate for differences in the patient population. This is because the processes of care in the measures apply to

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Office of Minority Health

Details: health, communities including racial and ethnic minorities, sexual and gender minorities, individuals with disabilities, and those living in rural areas, experience a lower quality of care and worse health outcomes than their non-minority counterparts.xxvii,xxviii,xxix Disparities persist,

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Outcome and Assessment Information Set OASIS-D

Details: the exception of maternity patients) in 1999. Since 1999, numerous changes have occurred within the health care system, including specific recommendat ions for changes in the area of home health care quality measurement. • Currently the main reason for revising OASIS is …

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CMS Selects Winner and Runner-Up in Artificial

Details: The CMS AI Health Outcomes Challenge attracted innovators from all sectors – not just from healthcare – to harness AI solutions to predict health outcomes for Medicare beneficiaries. From the initial group of more than 300 entries, the Challenge progressed through several stages, and participants were narrowed down to the top 25 and then

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› Url: https://www.cms.gov/newsroom/press-releases/cms-selects-winner-and-runner-artificial-intelligence-health-outcomes-challenge Go Now

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Definition and Uses of Health Insurance Prospective

Details: Under the home health prospective payment system (HH PPS), from October 1, 2000 to December 31, 2019, Original Medicare made a case-mix adjusted payment for up to 60 days of care using Home Health Resource Groups (HHRG). The HHRGs were represented on claims as HIPPS codes. Home health

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› Url: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/Downloads/hippsuses.pdf Go Now

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CMS Proposes Rule to Increase Price Transparency, Access

Details: The Centers for Medicare & Medicaid Services (CMS) is proposing actions to address the health equity gap, ensure consumers have the information they need to make fully informed decisions regarding their health care, improve emergency care access in rural communities, and use lessons learned from the COVID-19 pandemic to inform patient care and quality measurements.

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› Url: https://www.cms.gov/newsroom/press-releases/cms-proposes-rule-increase-price-transparency-access-care-safety-health-equity Go Now

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HEALTH ASSURANCE PENNSYLVANIA INC. TO OFFER MEDICARE

Details: Health Assurance Pennsylvania, based in Pittsburgh, is now serving Medicare beneficiaries in Allegheny County, including the city of Pittsburgh. Beneficiaries can sign up for the plan during the current Medicare+Choice open enrollment. Health Assurance Pennsylvania is a subsidiary of Coventry Health Care Inc., based in Bethesda, Md.

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