masonodonnel923's Space http://masonodonnel923.posterous.com Most recent posts at masonodonnel923's Space posterous.com Fri, 18 May 2012 11:54:00 -0700 Improved Medicaid Payment for Primary Care http://masonodonnel923.posterous.com/improved-medicaid-payment-for-primary-care http://masonodonnel923.posterous.com/improved-medicaid-payment-for-primary-care Distributed by Heath magazine in Spanish

Outline

CMS is releasing a projected procedure to implement a provision of the Affordable Care Act, as contained in section 1202 of the Health Care and Education Reconciliation Act of 2010, that offers increased expenses for specific Medicaid primary care professional services. Under this provision, some specific health professionals that provide allowed primary care assistance would be remunerated the Medicare rates in effect in calendar years (CY) 2013 in addition to 2014 (or if greater, the Medicare rate in place in 2009) as an alternative to their conventional state-established Medicaid rates, which may be less than federally developed Medicare charges. Enhanced fees applies to primary care expert services provided by a specialist with a specialty designation of family medicine, general internal medicine, or pediatric medicine as well as pertaining subspecialists. States can get 100 percent Federal financial participation (FFP) for the difference between the Medicaid State program payment amount as of July 1, 2009 together with the official Medicare rate. The increase refers to a specific group of services and types of procedures that CMS designates as “primary care services”.

The particular concept provides you with info about just how CMS and States will attempt to work as a group to make the improved payments in place. The guidelines contain data about the classification of eligible providers and services and how to satisfy the statutory prerequisites when making such payments for expert services provided through managed care. The guidelines also has information about how this plan is good for the Vaccines for Children (VFC) program, which contains its own statutory details for billing as well as payment.

Qualifying Suppliers

Under the Affordable Care Act, primary care services qualified to apply for the higher payment may be offered by a health care provider who specializes in family medicine, general internal medicine, or pediatric medicine. In the projected guideline, we specify that subspecialists associated with these primary care specialists are entitled to the improved payment. We as well clarify that services needs to be offered under the Medicaid healthcare practitioner services benefit. What this means is larger payment would be specifically for primary care services offered by practitioners-including, for instance, nurse practitioners-working under the authority of the qualified practitioner and billing under that physician’s Medicaid provider number.

putting into practice the Increased Payments in Fee for Service and Managed Care

The projected practice allows States two solutions: (1) “lock” rates at the standard of the Medicare physician service fee schedule effectively early in 2013 and 2014; or (2) modify the rates in conjunction with all changes made by Medicare. The rule provides that most of the details associated with the improved payments apply to products and services remunerated by Medicaid managed care plans. We recommend that States implement the improved payment into agreements with such entities.

Interaction with the Vaccines for Children Program

The procedure proposes payment of vaccine administration expenses under the VFC program at the smaller of the VFC regional highest administration fee (the VFC “ceiling”) or the Medicare charges in 2013 and 2014, whichever cost is least expensive. This is consistent with VFC plan specifications which restrict payments to the VFC ceiling, that is certainly the total billed by the provider, and to one payment per vaccine administered. Due to the fact the VFC ceiling rates were given on an interim basis in 1994 and have never been kept up to date, we are recommending to update these rates by rising them as mentioned by the Medicare Economic Index (MEI), which is a measure of medical practice cost inflation.

Please dont forget to visit Hispanic Health magazine to have access to more health topics

Permalink | Leave a comment  »

]]>
http://posterous.com/images/profile/missing-user-75.png http://posterous.com/users/lFbGLob0i7TLA masonodonnel923 masonodonnel923
Thu, 17 May 2012 10:00:00 -0700 Amplified Medicaid Payment for Primary Proper care http://masonodonnel923.posterous.com/amplified-medicaid-payment-for-primary-proper http://masonodonnel923.posterous.com/amplified-medicaid-payment-for-primary-proper Distributed by Heath magazine in Spanish

Summary

CMS is issuing a suggested guide to put into effect a provision of the Affordable Care Act, as included in section 1202 of the Health Care and Education Reconciliation Act of 2010, that provides greater expenses for certain Medicaid primary care expert services. Under this provision, various health professionals that offer qualified primary care assistance can be paid the Medicare rates appropriately in calendar years (CY) 2013 and even 2014 (or if greater, the Medicare rate in effect in 2009) as an alternative to their normal state-established Medicaid rates, which might be lesser than federally established Medicare charges. Greater remuneration applies to primary care services provided by a specialist with a specialized status of family medicine, general internal medicine, or pediatric medicine or associated subspecialists. States can get completely Federal financial participation (FFP) for the main difference between the Medicaid State program payment amount as of July 1, 2009 together with the valid Medicare rate. The increase applies to a certain list of expert services and types of procedures that CMS designates as “primary care services”.

The proposed procedure offers data about how CMS and States can work at the same time to make the increased payments operational. The guidelines incorporates facts about the verification of competent providers and services and how to meet the statutory prerequisites when making those payments for expert services presented through managed care. The professional guidance has information and facts on how this protection plan works for the Vaccines for Children (VFC) plan, containing its own statutory criteria for billing together with payment.

Qualifying Suppliers

Under the Affordable Care Act, primary care services qualified to apply for the increased payment can be delivered by a health care provider who specializes in family medicine, general internal medicine, or pediatric medicine. In the presented regulation, we make clear that subspecialists connected to these primary care professionals are eligible for the improved payment. We as well make clear that products and services is required to be delivered under the Medicaid healthcare practitioner services benefit. What this means is higher payment can be specifically for primary care services presented by practitioners-including, for example, nurse practitioners-working under the guidance of any qualified healthcare practitioner and billing under that physician’s Medicaid provider number.

Implementing the Increased Payments in Fee for Service and Managed Care

The presented practice would allow States a couple of alternatives: (1) “lock” rates at the level of the Medicare healthcare professional service fee schedule effectively early in 2013 and 2014; or (2) modify the rates in conjunction together with all revisions created by Medicare. The rule presents that most of the details in relation to the raised payments apply to services rewarded by Medicaid managed care plans. We suggest that States include the higher payment into documents with such entities.

Interaction with the Vaccines for Children Program

The guideline advises payment of vaccine administration rates under the VFC program at the lesser of the VFC regional highest administration fee (the VFC “ceiling”) or the Medicare prices in 2013 and 2014, whichever fee is lowest. This really is consistent with VFC plan policies which control payments to the VFC ceiling, which is certainly the total amount charged by the service provider, and to one payment per vaccine provided. Just because the VFC ceiling rates were issued on an interim basis in 1994 and have never been updated, we are now proposing to update these rates by boosting them as mentioned by the Medicare Economic Index (MEI), which is a measure of medical practice cost inflation.

Please dont forget to visit Hispanic Health magazine to have access to more health topics

Permalink | Leave a comment  »

]]>
http://posterous.com/images/profile/missing-user-75.png http://posterous.com/users/lFbGLob0i7TLA masonodonnel923 masonodonnel923
Thu, 17 May 2012 09:42:00 -0700 Increased Medicaid Payment for Primary Proper care http://masonodonnel923.posterous.com/increased-medicaid-payment-for-primary-proper http://masonodonnel923.posterous.com/increased-medicaid-payment-for-primary-proper Distributed by Salud al dia magazine

Summary

CMS is providing a particular policy to put into action a provision of the Affordable Care Act, as contained in section 1202 of the Health Care and Education Reconciliation Act of 2010, that offers raised payments for specific Medicaid primary care services. Under this provision, several health professionals that offer eligible primary care service should be remunerated the Medicare rates in effect in calendar years (CY) 2013 and even 2014 (or if greater, the Medicare rate in place in 2009) instead of using their standard state-established Medicaid charges, which might be lesser than federally accepted Medicare rates. Greater remuneration applies to primary care benefits provided by a physician with a specialty classification of family medicine, general internal medicine, or pediatric medicine or even related subspecialists. States are receiving 100 percent Federal financial participation (FFP) for the difference between the Medicaid State plan payment amount as of July 1, 2009 and the valid Medicare rate. The increase is good for a specific list of expert services and procedures that CMS designates as “primary care services”.

The projected concept will provide info about just how CMS and States will work together to put together the increased payments operational. The guidelines includes information regarding the verification of accepted service providers and expert services and how to satisfy the statutory prerequisites when generating these particular payments for products and services given through managed care. The information also provides information and facts regarding how this procedure is valid for the Vaccines for Children (VFC) program, which contains its own statutory prerequisites for billing as well as payment.

Qualifying Providers

Under the Affordable Care Act, primary care services eligible to the higher payment may be offered by a health care provider who specializes in family medicine, general internal medicine, or pediatric medicine. In the suggested guideline, we clarify that subspecialists connected to all these primary care health specialists are entitled to the enhanced payment. We also make clear that services has to be provided under the Medicaid healthcare practitioner services benefit. This simply means higher payment should be specifically for primary care services provided by practitioners-including, as an illustration, nurse practitioners-working under the direction of the qualifying physician and billing under that physician’s Medicaid provider number.

Implementing the Increased Payments in Fee for Service and Managed Care

The recommended rule will allow States two selections: (1) “lock” rates at the standard of the Medicare healthcare professional fee schedule effectively early in 2013 and 2014; or (2) adjust the rates in conjunction with all changes designed by Medicare. The rule will provide that all of the requirements relating to the enhanced payments apply to services rewarded by Medicaid managed care plans. We advise that States incorporate the raised payment into legal agreements with such entities.

Interaction with the Vaccines for Children Program

The procedure advises payment of vaccine administration service fees under the VFC system at the lesser of the VFC regional maximum administration cost (the VFC “ceiling”) or the Medicare charges in 2013 and 2014, whichever rate is most competitive. This really is in accordance with VFC plan regulations which control payments to the VFC ceiling, which happens to be the amount billed by the provider, and to one payment per vaccine applied. By reason that the VFC ceiling rates were given on an interim basis in 1994 and have never been kept up to date, we have been showcasing to update these rates by boosting them as suggested by the Medicare Economic Index (MEI), which is a measure of medical practice cost inflation.

Please dont forget to visit Hispanic Health magazine to have access to more health topics

Permalink | Leave a comment  »

]]>
http://posterous.com/images/profile/missing-user-75.png http://posterous.com/users/lFbGLob0i7TLA masonodonnel923 masonodonnel923