Mar 19, 2019 | Behavioral, Drugs, Products, Substance Abuse
The healthcare sector is mobilizing to combat opioid addiction. BRG expert Bryan Cote discusses how healthcare executives and investors will be instrumental in the coming years, including what existing efforts are worth watching and what risks lie ahead. Click to read more.
Jan 15, 2019 | Autism, Behavioral
Stakeholders worked with the American Medical Association (AMA) to make Applied Behavior Analysis (ABA) codes permanent, effective January 1, 2019. The change is viewed favorably by ABA providers. In addition to other small changes, it is expected that payers will have more difficulty challenging the legitimacy of service. This brief highlights some of the changes. Click to read more.
Jan 8, 2019 | Autism, Behavioral
BRG analysis of national commercial data shows that spending on Applied Behavioral Analysis (ABA) services for autism grew significantly from 2015 to 2017, while the levels of spending vary significantly by geography. This brief explores these data findings and highlights reasons for this growth. Click to read more.
Dec 11, 2018 | Behavioral, Medicaid
Last month, CMS announced a new demonstration opportunity to expand Medicaid inpatient mental health treatment services. A long-standing restriction has prohibited the Medicaid program from paying for services provided to adults in an institution for mental disease (IMD), but recent federal activity, including this demonstration, has significantly loosened the IMD exclusion. Waiver approval is contingent on states providing a complete continuum of care, with actions that are linked to CMS-defined goals and milestones. 12 states have already expressed interest in this type of waiver, and more...
Aug 28, 2018 | DMEPOS, Physician Fee Schedule, Physicians, Substance Abuse
Every year, CMS releases Comparative Billing Reports (CBRs) to about 10-12 provider groups. CBRs are issued in the form of letters sent to individual providers which analyze and compare individual provider billing patterns with other similar providers in their state and nationally. Typically, CBRs are inspired by past or pending OIG reports or other concerns raised about basic billing patterns, so they effectively put providers on alert that their specialty is being given extra attention, and makes them aware if they are outliers among billers in their specialty. In this brief, we have...
Aug 8, 2018 | Inpatient Psych, Inpatient Rehab (IRF), Post-Acute Care
CMS recently finalized a +1.1% update to the Inpatient Psychiatric Facility (IPF) Prospective Payment System (PPS). This brief summarizes updates that will be effective for discharges occurring during fiscal year 2019 and the IPF Quality Reporting Program (QRP). Click to read more. Likewise, CMS finalized a +1.3% update to the Inpatient Rehabilitation Facility (IRF) PPS, which will be effective for discharges occurring during fiscal year 2019 and the IRF QRP. This brief summarizes key provisions included in the final rule. Click to read more.
