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  • Overcoming Obstacles to Profitability
    October 27, 2019

    Nonprofit skilled nursing facilities can learn valuable lessons from for-profit and nonprofit operators that have succeeded in maintaining profitability, despite the challenges of declining reimbursement rates.

  • Profit is Not a Dirty Word
    October 11, 2019

    Joe Tomaino, CEO of Grassi Healthcare Advisors, explains why not-for-profit skilled nursing facilities should think differently about profitability and develop plans for sustaining it.

  • Alert: Anthem's New Prepay Review Policy
    August 28, 2019

    Anthem's new prepay review policy gives practices time to get the house in order!

  • Practice Risk and Provider Accountability
    January 28, 2019

    Keeping up-to-date with all the change in healthcare today can be overwhelming—it literally feels like a full-time job staying ahead of the curve when it comes to compliance with state and federal regulations, managed care and commercial payer requirements regarding billing, coding, and documentation content compliance. 

  • What to Expect in 2019?

    In the coming year, we expect to see continued industry pressures related to squeezes on reimbursement and pressure for improved outcomes and efficiency. 

  • Compliance Alert: CMS Postpones proposed changes to Evaluation and Management Services to 2021

    CMS released the final Physician Fee Schedule (PFS) rule on November 1, 2018 and expects to publish it on November 23, 2018. 

  • E-Alert: Statewide Healthcare Facility Transformation Funding II

    It is our understanding that the announcement of the awards for the New York Statewide Healthcare Facility Transformation Funding II offering will be made in mid-November, followed shortly after by a release of an RFP for New York Statewide Healthcare Facility Transformation Funding III. 

  • EAlert: CMS Final Rule -- Be Heard on E/M Changes

    In the Final Rule for 2019, CMS proposes to answer the call of providers to revise E/M coding & documentation for both new and established outpatient visits. The impact to your practice could be significant.

  • EAlert: Outpatient Rehab Therapy Changes

    Both the Bipartisan Budget Act of 2018 and the CMS Proposed Final Rule bring changes to Outpatient Rehabilitation Therapy services.


  • EAlert: CMS Patients over Paperwork

    CMS Patients over Paperwork initiative may bring about big changes to the way physicians are currently utilizing Evaluation and Management codes and  their documentation requirements. 

  • EAlert: OMIG to Target Managed Care Services – How do you look?

    As Medicaid providers you are aware that NYS OMIG has altered their Work Plan from an annually published plan to a dynamic or rolling plan—which is adjusted throughout the fiscal year to adapt to the changing healthcare demands. This week OMIG announced several new initiatives, but the one that caught our eye is that which will target Managed Care Network Providers.

  • EAlert: Important Updates in BH and Telehealth

    Important Updates in the 2018 CMS Final Rule for Physician and Behavioral Health Services! IMPORTANT UPDATE #1:The Rule Shows Improvement of Payment Rates for Non-facility and Office-based Behavioral Health Services. CMS is in the process of finalizing an improvement in the way Medicare Physician Fee Schedule (MPFS) rates are set that will positively impact office-based behavioral health services.

  • E-Alert: Important Information for Behavioral Health Providers

    2018 Final Rule – Shows Improvement of Payment Rates for Office-based Behavioral Health Services
    CMS is in the process of finalizing an improvement in the way Medicare Physician Fee Schedule (MPFS) rates are set that will positively impact office-based behavioral health services.

  • Telegraph, Telephone, Telehealth! The New Wave for Healthcare Delivery by Stephanie Fiedler

    For many years in Rural Health Professional Shortage Areas (HPSA) or in Metropolitan Statistical Areas (MSA), Medicare has supported Telehealth services due to the lack of certain types of medical professionals in identified geographic areas. Many Medicaid programs followed suit for similar reasons although they did not require the service to be delivered in HSPAs or MSAs.

  • More Bundles of Opportunity and Risk—Are You Ready? by Joseph Tomaino

    CMS released proposed rules for expansion of the bundled payment program for Medicare fee-for-service beneficiaries.  This expands the current Comprehensive Care for Joint Replacement (CJR) program implemented in 67 Metropolitan Statistical Areas (MSA) across the country.

  • Integration of Primary Care and Behavioral Health-What Providers Fear Most  by Joseph Tomaino

    The focus on value-based care and the associated initiatives that support it (accountable care, managed care, bundled payments, DSRIP, etc.) has forced providers to address the mind-body connection and its impact on utilization of health care resources.