Part B Insider (Multispecialty) Coding Alert

The Centers for Medicare & Medicaid Services (CMS) has chosen six organizations to participate in the three-year demonstration Care Management for High Cost Beneficiaries (CMHCB). CMS chose ACCENT, Care Level Management, Massachusetts General Hospital and Massachusetts General Physicians Organization, Montefiore Medical Center, RMS DM, LLC, and Texas Senior Trails.

The participating organizations will receive a monthly fee for each Medicare beneficiary involved in the demonstration to cover administrative and care management costs. But organizations must "assume financial risk if they do not meet established performance standards for achieving savings to Medicare," CMS says.

Beneficiary enrollment in the CMHCB program will begin in the fall of 2005. CMS hopes that the CMHCB demonstration will promote evidence-based care, reduce unnecessary emergency room visits and hospital stays, and help patients avoid complications through various models. These models include support programs for healthcare coordination, self-care and caregiver support, physician and nursing home visits, use of in-home monitoring devices and 24-hour nurse telephone lines, education, outreach, tracking and reminders of patients' preventative care needs, and behavioral healthcare management.