May 30, 2018 | Dental, Medicaid
On May 4, CMS issued an Informational Bulletin to states reminding them of their obligation to ensure that dental payment policies are aligned with periodicity schedules and that such schedules represent a “floor” rather than “ceiling” for coverage. Click to read more.
May 25, 2018 | Managed Care Friday
1. 24 to 7: No, this is not my prediction for the next Super Bowl score (Patriots over the Giants), but rather the number of people in millions who suffer from Cataracts in the U.S compared to the 7.7 million with diabetic retinopathy. In contrast, 2.7 million suffer from glaucoma, and 2.1 million from age-related macular degeneration. Eye disease prevalence is a national and global health concern that is higher in risk for chronic health conditions, accidents, social withdrawal, and depression. 2. Drug Testing Limits: Regence BCBS, starting in July will only allow payment for specific codes...
May 24, 2018 | Physician Fee Schedule, Physicians
Medicare Part B reimburses for physician services according to the physician fee schedule (PFS). The MPFS includes over 7,000 physician service codes and their payment rates. In this brief, we’ll provide an overview of how payments are determined, and how rates can be as much as 20% to 25% higher due to geographic adjustments, as our example for cataract procedures highlights. Click to read more.
May 22, 2018 | Inpatient Psych
CMS recently released proposed updates to the Inpatient Psychiatric Facilities (IPF) Prospective Payment System (PPS). The proposed rule would update the IPF Quality Reporting Program and prospective payment rates for discharges occurring during FY2019. Click to read more.
May 21, 2018 | Inpatient Rehab (IRF)
On April 27, CMS released proposed updates to the FY2019 Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS). The proposed rule includes updates to IRF payment rates, changes to the IRF quality reporting program, and revisions to IRF coverage requirements. This brief will discuss highlights from the proposal. Click to read more.
May 18, 2018 | Managed Care Friday
1. 71: Percent of colon cancer cases that appear to be preventable through proper nutrition, 30-minutes of daily exercise, and not smoking or being obese, factors that account for 78% of chronic disease risk. 2. Enter Your Own Clinical Notes: Elaine Benes would have loved this. 15% of physician offices in our poll of 316 groups say they are starting to create a system to allow patients to provide input into their medical records. Elaine was ticked, for you Seinfeld fans, when her doctor fake erased her feedback about her rash. Patients of physicians Georgia and South Carolina, will be able...
May 14, 2018 | Medicare, Physicians
The CMS Innovation Center (CMMI) recently announced that it is exploring a direct provider contracting (DPC) initiative to enhance the physician-beneficiary relationship. Such a model would permit providers to have increased accountability for the cost and quality of a designated population in efforts to improve beneficiary outcomes. CMMI has put forth an RFI as it works to develop a model. Meanwhile, some beneficiary advocates are skeptical, as they believe it may discriminate against lower-income individuals. Click to read more.
May 11, 2018 | Managed Care Friday
1. 1.7 Million: Number of children under the age of 18 with major depressive episodes who did not receive treatment, according to the Suicide Prevention Resource Center. That’s enough to fill every major league baseball stadium on the east coast twice. There is a shortage of providers as well. In Alabama, there’s only one mental health professional per 1,260 people. To meet the need for mental health care, providers in the lowest ranked states would have to treat six times as many people than providers in the highest ranked states 2. MCO Monthly Rate For Rx: Tennessee’s Medicaid program...
May 10, 2018 | Medicare Advantage, MedPAC
At MedPAC’s April Public Meeting, the Commission discussed opportunities through which Medicare Advantage (MA) encounter data could be used to improve administration of the MA program. This brief provides an overview of Medicare encounter data and some preliminary recommendations by MedPAC for ways to improve the quality of the data. Click to read more.
