Emergency Department Coding Patterns

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.

Managed Care Friday

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,...

Managed Care Friday

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...

North Carolina Medicaid Suspends Implementation of Managed Care

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.

Managed Care Friday

Jan 10, 2020 | Managed Care Friday

50,000: The number of Medicaid enrollees Molina gains in Illinois’ Cook County now that it has just agreed to acquire the Medicaid managed care organization NextLevel Health Partners, which is a community-based health plan focused on social determinants. Home Rx: Beginning January 1, 2020, members of Oscar’s insurance plan in New York can select Capsule’s same-day pharmacy service through the Oscar app to start receiving meds straight to their homes at no cost. Yelp The Doctor: Cigna is now giving 5 specialists access to patient reviews and will likely add 7 others this year to help both...

NY Medicaid Cuts Rates 1% Across the Board

Jan 8, 2020 | Medicaid

As a first step toward addressing an anticipated $6 billion budget deficit for state fiscal year 2020, the New York Medicaid program announced an across-the-board 1% rate cut effective January 1, 2020. The cut affects rates for the majority of Medicaid services as well as capitation rates paid to managed care plans. Click to read more.