Exploring recent Medicare Advantage changes on the January NAHRI Quarterly Call

Wednesday, February 14, 2024

NAHRI members received association updates and insights on recent Medicare Advantage (MA) regulatory changes during the January 2024 NAHRI Quarterly Call.

Association updates

The call opened with NAHRI Director Nicole Votta providing the latest association updates.

The 2024 Revenue Integrity Symposium (RIS) will be held September 12-13, 2024, at the Hilton Chicago/Oak Brook Hills Resort & Conference Center in Oak Brook, Illinois. RIS is the premier event for revenue integrity, revenue cycle, and Medicare compliance education and networking. Attendees will learn from trusted experts with cutting-edge insights that will empower them to ensure compliance with regulatory changes, maximize revenue, enhance workflow, and improve program design.

2024 Revenue Integrity Week will take place June 3-7. This year’s theme will be Your Career in Bloom! This event celebrates revenue integrity professionals and raises awareness of their contributions to the healthcare industry. Ahead of the event, NAHRI will release the 2024 Revenue Integrity Week toolkit, which includes activities, games, banners, a poster, and more. The 2024 State of the Revenue Integrity Industry Survey is currently open, and the survey data will be compiled into a report released during Revenue Integrity Week. Give your outstanding colleagues the recognition they deserve during Revenue Integrity Week through NAHRI’s Peer Recognition Program.

MA updates

Following the association updates, NAHRI Advisory Board member Ronald Hirsch, MD, FACP, CHCQM, CHRI, vice president of physician advisory solutions with R1 RCM, Inc., reviewed recent MA regulatory updates, focusing on inpatient admissions.

Hirsch detailed items that MA plans are required to recognize as of January 1, 2024, such as the two-midnight rule and inpatient-only list.

Hirsch also touched on specific requirements for home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities, recommending hospitals take extra steps to verify these requirements to secure appropriate placement.

Hirsch identified several elements that have not been impacted by recent MA changes, including long-term acute care hospital (LTACH) admissions. He reminded listeners that to get MA approval for an LTACH transfer, a hospital must prove that the LTACH can provide specialized care that it cannot. Of note, the ambulatory surgical center covered procedures list also has not been affected. Hirsch theorized that this could change through further rulemaking.

A recording of the January Quarterly Call is available for NAHRI members here. Stream more past calls here. Listening to or presenting on Quarterly Calls award one CHRI CEU. Register now for our 2024 series of calls. If you would like to present on an upcoming call, please contact NAHRI at nahri.@hcpro.com.