Medicare Compliance & Reimbursement
TRIO OF HEALTH PLANS TAPPED FOR MEDICARE DM PILOT
Will disease management find a happy home in Medicare? Health plans that haven't yet jumped into disease management may want to make the move soon - the Centers for Medicare & Medicaid Services is pushing to find out how DM should work in Medicare, and the fruits of a series of pilot projects could lay the groundwork for the future. In the latest development, CMS Nov. 18 unveiled the names of three organizations tapped to take part in a pilot aimed at chronically ill Medicare patients suffering from heart problems and complex diabetes. Rosemont, IL-based CorSolutions, Diabetex/XLHealth of Baltimore and Santa Ana, CA-based HealthPartners SM will recruit up to 30,000 Medicare beneficiaries in California, Arizona, Louisiana and Texas for the project, under which Medicare will provide payment for all disease management services - not just those related to the beneficiaries' chronic conditions - along with prescription drug costs. CMS aims to figure out how DM can help improve outcomes for Medicare fee-for-service patients without increasing costs. Express Scripts will provide pharmacy benefit services for CorSolutions, PBM Plus for Diabetex/XL Health and Pacificare's Prescription Solutions for HealthPartners SM. The pilot is only the latest in a series of initiatives launched by CMS in recent years. Other ongoing projects have targeted patients with congestive heart failure, chronic obstructive pulmonary disease and other conditions. Lesson Learned: Providers of DM services could have big opportunities in store as CMS probes for ways to make it work in Medicare.
Medicare Compliance & Reimbursement
- Home Health:
HHA PAYMENT CUT SLATED FOR APRIL
Medicare bill a mixed bag for HHAs. It will take experts months to suss out [...] - Rehab:
CONGRESS PUTS A CAP IN THE THERAPY CAPS
Thanks to rehab providers' tireless lobbying efforts, they can kiss the much-maligned therapy caps goodbye [...] - Payment Errors:
ARE PAYMENT ERRORS WORSE THAN CMS SAYS?
Senate fraud hawk chides CMS with tinkering with error figures. Health care providers shouldn't jump to [...] - Disease Management:
TRIO OF HEALTH PLANS TAPPED FOR MEDICARE DM PILOT
Will disease management find a happy home in Medicare? Health plans that haven't yet jumped [...] - DME:
SUPPLIERS BID FAREWELL TO ANTI-BIDDING HOPES
No good news for DME in newly passed legislation. The new prescription drug benefit is [...] - Rehab:
REHAB PROVIDERS CHEER FEE SCHEDULE FIX
2004 physician fee schedule speaks to PT-OT-and SLP-specific issues. Congress stepped in to save rehab [...] - Psychiatric Facilities:
7 KEY ELEMENTS OF THE INPATIENT PSYCH FACILITY PPS PROPOSAL
2,000 psychiatric hospitals and units brace for a new reimbursement era. Yet another class of [...] - People:
SCULLY TO STEP DOWN
Tom Scully is leaving his post as Centers for Medicare & Medicaid Services Administrator, effective [...] - Labs:
LAB FRAUD FIGHTERS CAST A WIDE NET
Golden State lab operator snared in $1.3 million fraud. When it comes to health care [...] - Labs:
THE WRONG INSTRUCTIONS COULD LEAD TO A CLIA CITATION
What labs should watch for on tests that could be waived or moderate complexity. Labs had [...] - BILL WATCH
The following bill was introduced in the Senate before it adjourned for the holidays: S. [...] - CME MANUAL UPDATE
Providers of ambulance services can gain a bit of insight into how carriers calculate the [...]
