Jan 27, 2020 | Hospitals, Medicare, MedPAC
Comparative Billing Reports (CBRs) are disseminated to the Medicare provider community to provide insight into Medicare policy and regional billing trends. A CBR analysis has recently been released for emergency departments billing patterns. Click to read more.
Jan 24, 2020 | Managed Care Friday
13: Number of newly awarded contracts that BCBS is going to give out this year alone to physical education vendors focused on movement, exercise and fitness solutions to address both physical and mental health, a spokesman confirmed. Companies will focus on chronic adult patients, seniors, new moms and youth as part of tailored programs designed to limit prescriptions and reduce stress and downstream medical complications of events such as stroke. One of the leading ‘companies’ in the mix, PLAY, previously had a grant with BCBS of Rhode Island, while others are more data and fitness focused,...
Jan 23, 2020 | Medicare, Medicare Advantage
In January, CMS proposed changes to the 2021 risk adjustment model for Medicare Advantage plans – a key component of MA payments – including more reliance on MA encounter data to adjust payments for enrollees’ health. CMS projects a +0.25%, or $566m, impact on total plan payments because of these changes. Click to read more.
Jan 17, 2020 | Managed Care Friday
Four: Autism is 4x more common in boys and ADHD prescribing is far more common too, spurring a new wave of sports-focused programs led by counselors, coaches and educators that take the principles of applied behavioral analysis and put them into practice. Literally. Several models have popped up as alternative offerings for parents whose idea of a win is not measured in points or playing time or whether Robby will make the elite team, but in exercise, focus, social development. One of the earlier models we covered is discussed here. Expect continued interest in these alternative models as...
Jan 15, 2020 | Medicaid, Medicaid Managed Care
The North Carolina General Assembly adjourned in November 2019 without providing new spending and program authority that was required for the transition to Medicaid managed care. As a result, the state’s Department of Health and Human Services suspended managed care implementation indefinitely, and open enrollment will not go live, as anticipated, on February 1, 2020. Click to read more.
