If you came across my recent report on the significant concern of “maternity deserts” in the U.S., as you will recall, the widely accepted definition of the phenomenon is any county lacking maternity care units.
The Centers for Medicare & Medicaid Services (CMS) just released news that they will be working on a 10-year payment and care delivery model called the Transforming Maternal Health Model (TMaH). This model strives to support participating state Medicaid agencies in developing and implementing a whole-person approach to pregnancy, childbirth, and postpartum care for women with Medicaid and Children’s Health Insurance Program (CHIP) coverage.
There are not a lot of details yet on how this program is going to be fleshed out, other than generic reference to key terms such as data, research, and evidence-based practice. However, I anticipate that more information will be coming in the first quarter of this year.
What we know so far is the following:
CMS is planning to release a notice of funding in the spring of 2024, with application submission requirements later in the year. Only 15 states will be awarded acceptance, with kickoff in January 2025.
Although I am thankful for the financial opportunity, and I don’t want to appear ungrateful, I am concerned about how this will end up trickling down to create scalable impact. Completing some quick math, $17 million divided per year would be $1.7 million annually for an entire state.
Let’s assume the Medicaid plan takes 20 percent prior to this going to the provider level, leaving $1.36 million to split – and this is just a conservative estimate. I am also concerned about what the other 35 states are going to do without the additional funding, as well as what health systems should consider for this year since funding would not begin until 2025. To learn more, click here: Transforming Maternal Health (TMaH) Model | CMS
Clinical documentation integrity (CDI) professionals work in a variety of settings, and although I mostly focus on topics related to hospital inpatient billing, this week
With so much focus within the federal government on abuse, fraud, and waste, I thought it might be helpful to review a couple of federal
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Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
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Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
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