Major insurer to test heart failure DM.
Payors seem to finally be wising up that an ounce of prevention is worth a pound of cure - and the result could be more home care patients.
A new study found that elderly heart failure patients who received specialized nursing care during their hospital stay and after discharge at home had better quality of life and fewer hospital readmissions.
Heart failure patients experience breakdowns in care during multiple transitions from hospital to home, says the study funded by the National Institutes of Health' National Institute of Nursing Research and published in the May issue of the Journal of American Geriatrics Society.
While furnishing the study participants with disease management care cost more up front than regular hospital services, the reduction to hospital admissions saved the Medicare program 38 percent overall - $4,845 per patient, found the study conducted by University of Pennsylvania researchers.
A "major health insurer" has launched a $1 million pilot project to test the study's findings in New Jersey, Delaware and Pennsylvania this summer, NIH says in a release.
Advanced practice nurses visited study patients within 24 hours of hospital admission and, upon discharge, the nurses conducted home visits within 24 hours of discharge and were available by phone. If you're having trouble deciphering the reasons your claims are getting denied, check out the full list of remittance advice codes at
www.wpc-edi.com/codes/Codes.asp. The list is updated three times a year, Palmetto GBA says on its Web site.
Starting last month, remark code N115 has been telling providers the claim was denied due to a local medical review policy or local coverage determination. And starting this October, beneficiaries' Medicare Summary Notices will contain that message as well, plus any relevant national coverage determination, along with the specific LMRP, LCD or NCD number used for the denial, the Centers for Medicare & Medicaid Services says in May 14 Transmittal No. 75.
"For each full or partial denial that is based on an LMRP or NCD, the MSN will have to specify the LMRP/LCD ID number(s) and/or NCD number(s) of the [policies] that were used," CMS tells contractors.
Wheelchair suppliers will receive a 90-day grace period on the 20 new wheelchair cushion K codes that went into effect July 1, CMS says in May 14 Transmittal No. 179 (see Eli's HCW, Vol. XIII, No. 6, p. 48). Suppliers have until Sept. 30 to transition from using the 11 old E codes and three old K codes for the items. Now that former Palmetto durable medical equipment regional carrier medical director Paul Metzger has so vocally joined the ranks of providers (see Eli's HCW, Vol. XIII, No. 3, p. 19), the DMERC has appointed a new medical director. Dr. [...]
