Discount |

CMS is allowing Medicare Advantage plans to cross negotiate Part B and D drug prices

Healthcare Finance - Susan Morse, Senior Editor - August 07, 2018 Starting in 2019, insurers may use step therapy to choose the least expensive drug first before moving on to another prescription. For the first time, Medicare Advantage plans that also offer a Part D benefit have the option of cross negotiating for Part B drugs to get the lowest price, the Centers for Medicare and Medicaid Services told MA organizations in a memo that went out today. Until now, Part B outpatient drugs and Medicare Part D drugs usually picked up at the pharmacy, have been kept separate. Part B drugs often have a competitor in Part D, but plans were not allowed to choose, according to CMS Administrator Seema Verma. Starting in 2019, MA plans that also offer a Part D benefit will be able to cross manage across B and D. In this way, competition is increased for the lower price, Verma said. It might help plans negotiate better discounts and direct patients to high value medications, she said. Part B drugs constitute around $12 billion per year in spending by plans. "As a result of the agency's action today, the Medicare Advantage plans that choose to offer this option will be able to have medicines in Part B compete on a level playing field with those in Part D," CMS said. The new guidance also allows plans to use step therapy, a practice banned in 2012. Step therapy gives the private sector MA plans the option of offering patients a preferred therapy first before moving on to another drug. It is a type of preauthorization for drugs that begins with the most preferred - which is often the least expensive therapy - [...]

By kristian|August 11th, 2018|Blog, Commercial Insurance, Consulting, Discount, doctor, doctor Credentialing, Health Insurance, Healthcare Changes, Healthcare Professionals, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Medicare, medicare claims, Obamacare, Physician Credentialing|Comments Off

Medicare Advantage Plans Can Pay for Many LTC Services in 2019: Feds

Plans could cover adult day care, respite care and in-home support services. By Allison Bell | May 02, 2018 at 10:27 AM The Centers for Medicare and Medicaid Services is getting ready to let Medicare Advantage plan issuers add major new long-term care benefits to their supplemental benefits menus. The Better Medicare Alliance, a Washington-based coalition for companies and groups with an interest in the Medicare Advantage has posted a copy of a memo that shows CMS is reinterpreting the phrase “primarily health related” when deciding whether a Medicare Advantage plan can cover a specific benefit. Kathryn Coleman, director of the CMS Medicare Drug & Health Plan Contract Administration Group, writes in the memo, which was sent to Medicare Advantage organizations April 27, that CMS will let a plan cover adult day care services for adults who need help with either the basic “activities of daily living,” such as walking or going to the bathroom, or with “instrumental activities of daily living,” such as the ability to cook, clean or shop. A Medicare Advantage plan could not, apparently, cover skilled nursing home care, or assisted living facility fees. But, in addition to adult day care, a Medicare Advantage plan could pay for: In-home support services to help people with disabilities or medical conditions perform activities of daily living and instrumental activities of daily living within the home, “to compensate for physical impairments, ameliorate the functional/psychological impact of injuries or health conditions, or reduce avoidable emergency and health care utilization.” Short-term “respite care” or other support services for family caregivers. Making non-Medicare-covered safety changes, such as installing grab bars, that might help people stay in their homes. Non-emergency transportation to health care services. (Plans can already [...]

By kristian|May 3rd, 2018|Blog, Commercial Insurance, Consulting, Credentialing, Discount, doctor, doctor Credentialing, Health Insurance, Healthcare Professionals, ICD-10, ICD-10, Medicaid, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Medicare, medicare claims, Obamacare, Physician Credentialing|Comments Off

BILL HR4302 PASSES, ICD-10 IMPLEMENTATION DELAYED UNTIL OCT 1, 2015

On April 1, President Obama signed into law a bill to delay the planned ICD-10 implementation until Oct. 1, 2015. Specifically, the bill prohibits CMS from enforcing a mandate to switch from ICD-9 to ICD-10 until Oct. 1, 2015. Details on implications to providers, health plans and technology companies in the health care industry are as yet unclear. Availity remains confident that we are prepared to accommodate any scenario that could unfold. We are committed to helping you operate a healthy, thriving business—even in an industry constantly redefined by change. Because we have solid yet flexible contingency plans for ICD-10 and other programs, you and your business will have the support you need. We are committed to preserving the uninterrupted flow of your administrative, clinical and financial information exchange on our networks, to assure continuous cash flow to your business. The Firm believes successful Physicians view their office as a business. In order to meet today’s healthcare needs of the patient, profits are critical for a Medical Practice to survive and thrive. As a trusted intermediary between payers, providers and other industry partners, the decision to delay the ICD-10 implementation will cause businesses to rethink their plans. As we consult with payers about their strategies, we will advise you on potential impacts to testing, training and implementation as soon as possible. The FIRM, with 30 years of combined experience specializes in Medical Billing, Credentialing and Consulting services to assist physicians and their staff to operate a more efficient, compliant and profitable medical practice. At The FIRM, optimal insurance reimbursement is our goal! The Firm’s expert medical billing staff understands the importance of excellent and efficient medical billing and collections as well [...]

By kristian|April 3rd, 2014|Blog, Chemical Dependency, Chiropractic, Chiropractor, Commercial Insurance, Consulting, Dentist, Discount, Doctor, Healthcare Changes, Healthcare Professionals, Medicaid, Medical, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Mental Health, Multi-Specialty, Opportunity, Optometrist, Personal Injury Negotiations, Physical Therapy, Podiatrist, Press, Specialties, Staff Training, Verification|Comments Off

Medical Billing – Credentialing- Insurance Claims Processing Management Professionals at The Firm Services

Medical Billing professionals at The Firm Services The FIRM provides professional claims billing services for individual providers, clinics and facilities. We service all disciplines of practice, i.e., medical, dental, diagnostic testing, chiropractic, physical therapy, optometry/ophthalmology, mental health, chemical dependency, and durable medical equipment. We offer specialty services such as consultation, collections and appeals, contracting and credentialing, verification and preauthorization and personal injury settlement negotiating. We offer form development and revision services, office reorganization and personnel training. Outsourcing your billing is advantageous and cost effective, consider the following key points: Minimal set up fee Cost of forms, paper, envelopes, postage, and ink for paper claims Cost and hassle for electronic claims submission Personnel costs to perform billing and fight denials Delays in billing and reimbursements: illness, vacation, unexpected absences, and termination of in-house staff Cost of ongoing training and education for billing personnel (claim and procedure changes), changes in codes, deletion of codes and other billing issues Unlimited, free support to answer questions and guide you The FIRM gives your billing undivided attention. The number one complaint from providers regardless of specialty concerning in house billing, is the billing persons’ constant interruptions, i.e., telephone, chart retrieval, assistance with patients, running off-site errands, filing, copying, faxing, etc. Practice analysis reports provided monthly, additional reports available upon request Remote access to your practices Credentialing Services: Credentialing for all carriers including all necessary follow up and tracking to completion of process.FIRM CREDENTIALING Medical-Billing-Compliance-Checklist Professional and affordable credentialing to allow you to focus on patient care Reduce your billing issues due to improper credentialing. Changes in your practice or business status effect your reimbursement. The FIRM can identify problem areas and know how to properly execute those changes [...]

By kristian|January 26th, 2014|Blog, Chemical Dependency, Chiropractic, Chiropractor, Commercial Insurance, Consulting, Dentist, Discount, Doctor, Healthcare Changes, Healthcare Professionals, Medicaid, Medical, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Mental Health, Multi-Specialty, Opportunity, Optometrist, Personal Injury Negotiations, Physical Therapy, Podiatrist, Press, Specialties, Staff Training, Verification|Comments Off

MEDICARE NEWS:

Congress Is Poised To Change Medicare Payment Policy. What Does That Mean For Patients And Doctors? Topics: Politics, Medicare, Delivery of Care, Health Costs By Mary Agnes Carey KHN Staff Writer Jan 16, 2014 After years of legislative wrangling and last-minute patches, expectations are high among physician groups, lawmakers and Medicare beneficiaries that Congress could act this year to permanently replace the current Medicare physician payment formula. While committees in both chambers have approved their own "doc fix" proposals, the approaches have yet to be reconciled, and none have identified how they would pay for a repeal. Below are some frequently asked questions and answers about the formula – known as the "sustainable growth rate" – and how Congress may change it. Q: What is the sustainable growth rate? A: Known as the SGR, the formula was created as part of a 1997 deficit reduction law designed to rein in federal health by linking physician payment to an economic growth target. For the first few years after it was created, Medicare expenditures did not exceed the target and doctors received modest pay increases. But in 2002, doctors reacted with fury when they came in for a 4.8 percent pay cut. Every year since Congress has staved off the scheduled cuts. But each deferral just increased the size – and price tag – of the fix needed the next time. Q: What is Congress doing to scrap the SGR and what would they replace it with? A: Two committees in the House – the Energy and Commerce and Ways and Means panels – and the Senate Finance Committee have passed bills that would repeal the SGR and replace it with a system of rewarding physicians based [...]

By kristian|January 17th, 2014|Blog, Chemical Dependency, Chiropractic, Chiropractor, Commercial Insurance, Consulting, Dentist, Discount, Doctor, Healthcare Changes, Healthcare Professionals, Medicaid, Medical, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Mental Health, Multi-Specialty, Opportunity, Optometrist, Personal Injury Negotiations, Physical Therapy, Podiatrist, Press, Specialties, Staff Training, Verification|Comments Off

OBAMACARE NEWS

Docs, Hospitals Cope With 'Trickle' Of Newly Insured Patients -- But Questions Continue About The Actual Number Jan 16, 2014 As the Wall Street Journal reports that one of the biggest issues right now is making sure these newly insured people have insurance cards, other news outlets detail reports and questions about the number of enrollees. The Wall Street Journal: Two Weeks Into Health Law’s Rollout, Few Problems, Few Patients Two weeks into the full rollout of the Affordable Care Act, hospitals and doctors say they are coping with the trickle of new patients relatively smoothly, but one of the biggest issues is making sure enrollees get insurance cards. The 2010 health law represented the biggest expansion of insurance coverage in a generation. Nonetheless, the number of people signing up so far for private coverage or Medicaid under the law is still a tiny fraction of all Americans with health insurance, partly because computer snafus hindered early enrollment (Corbett Dooren and Beck, 1/16). The Washington Post’s The Fact Checker: Warning: Ignore Claims That 3.9 Million People Signed Up For Medicaid Because Of Obamacare There is much less to the Medicaid figure than meets the eye. (The exchange figure has been updated recently, to 2.2 million, but not the Medicaid figure.) Indeed, there has been vast confusion about what this figure means, especially in the news media. The Fact Checker cited the 3.9 million figure in a few recent columns, but prodded by an interesting analysis by Sean Trende at Real Clear Politics, we decided to take a closer look (Kessler, 1/16). Kaiser Health News: Capsules: State Snapshots Of Obamacare Enrollment Numbers Enrollment in the health law’s marketplaces surged in December, and the administration’s report on the [...]

By kristian|January 17th, 2014|Blog, Chemical Dependency, Chiropractic, Chiropractor, Commercial Insurance, Consulting, Dentist, Discount, Doctor, Healthcare Changes, Healthcare Professionals, Medicaid, Medical, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Mental Health, Multi-Specialty, Opportunity, Optometrist, Personal Injury Negotiations, Physical Therapy, Podiatrist, Press, Specialties, Staff Training, Verification|Comments Off

AFFORDABLE CARE ACT

Key Features of the Affordable Care Act You will soon have access to health coverage, even if you have a pre-existing condition. And premium tax credits and other financial assistance will help you pay for health insurance if you are eligible. Below are some things you should know about the Affordable Care Act. If you want to get more detailed information about the new health care law, read about each of the provisions. The Health Insurance Marketplace offers a new way to shop and enroll in a health plan. Preventive services will have no out-of-pocket costs. Essential health benefits will be included in most health insurance plans. You can keep your adult children on your health insurance plan up to the age of 26. You choose your doctor. Emergency access is guaranteed. Health coverage is easier to understand. You can appeal if coverage is denied.

By kristian|January 17th, 2014|Blog, Chemical Dependency, Chiropractic, Chiropractor, Commercial Insurance, Consulting, Dentist, Discount, Doctor, Healthcare Changes, Healthcare Professionals, Medicaid, Medical, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Mental Health, Multi-Specialty, Opportunity, Optometrist, Personal Injury Negotiations, Physical Therapy, Podiatrist, Press, Specialties, Staff Training, Verification|Comments Off

Summary of Services