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1. Accountable Care Organizations: The Case For Flexible Partnerships Between Health Plans And Providers Under the Affordable Care Act, the new Center for Medicare and Medicaid Innovation will guide a number of experimental programs in health care payment and delivery. Among the most ambitious of the reform models is the accountable care organization (ACO), which will offer providers economic rewards if they can reduce Medicare’s cost growth in their […]...
2. How The Center For Medicare And Medicaid Innovation Should Test Accountable Care Organizations [Payment & Delivery] The Patient Protection and Affordable Care Act establishes a national voluntary program for accountable care organizations (ACOs) by January 2012 under the auspices of the Centers for Medicare and Medicaid Services (CMS). The act also creates a Center for Medicare and Medicaid Innovation in the CMS. We propose that the CMS allow flexibility and tiers […]...
3. Roundup: In Oregon, New Gov. Kitzhaber Vows To Change State’s Health Care Delivery System; In Ariz., 2nd Person Denied Transplant Coverage Dies Roundup: In Oregon, New Gov. Kitzhaber Vows To Change State’s Health Care Delivery System; In Ariz., 2nd Person Denied Transplant Coverage Dies...
4. Providers may collect SOC payments Providers may collect SOC payments from a subscriber on the date that services are rendered or providers may allow a subscriber to “obligate” payment for rendered services.  Obligating payment means the provider allows the subscriber to pay for the services at a later date or through an installment plan.  Obligated payments must be used by […]...
5. New Rule Proposed to Improve Employment of Veterans – Comment Deadline July 11 The U.S. Department of Labor has proposed a new rule to strengthen affirmative action requirements of federal contractors and subcontractors for Veterans protected under the Vietnam Era Veterans’ Readjustment Assistance Act of 1974 (VEVRAA). Comment deadline is July 11, 2011. Get Your Share of Cost Threshold with Dental Insurance Compare share of cost with dental insurance in the […]...
6. Lessons For The New CMS Innovation Center From The Medicare Health Support Program The Patient Protection and Affordable Care Act establishes a new Center for Medicare and Medicaid Innovation in the Centers for Medicare and Medicaid Services (CMS). The center is intended to enhance the CMS’s role in promoting much-needed improvements in payment and service delivery. Lessons from the Medicare Health Support Program, a chronic care pilot program […]...
7. Suspension of Entities Submitting Claims for Suspended Providers The July Update is a list of providers who have been added to or removed from the Medi-Cal Suspended and Ineligible Provider List (S&I List) for the month of July. New providers have been added in bold and reinstated providers were removed from the following lists: susp A, susp C, susp E, susp G, susp […]...
8. Share of Cost, High-quality preschool program produces long-term economic payoff High-quality preschool program produces long-term economic payoff ...
9. Rearranging the waiting room chairs Monique Garcia of the Chicago Tribune reports that the Illinois Senate voted 58-0 to enact a series of reforms to the state Medicaid system. As the vote indicates, the reforms are hard to argue with. Unfortunately, as I’ve reported, they do very little to resolve the state’s Medicaid financing crisis — a crisis that can […]...
10. Building Regulatory And Operational Flexibility Into Accountable Care Organizations And ‘Shared Savings’ The Affordable Care Act created accountable care organizations (ACOs), which will be a new part of Medicare as of January 2012, together with a “shared savings program” that will modify how these organizations will be paid to care for patients. Accountable care organizations have the potential to lower costs, improve the quality of care, facilitate delivery […]...
11. How to find out if a subscriber must pay a SOC Providers access the Medi-Cal eligibility verification system to determine if a subscriber must pay an SOC.  The message returned by the eligibility verification system includes the SOC dollar amount the subscriber must pay.  The eligibility verification system is accessed through the Point of Service (POS) device, Automated Eligibility Verification System (AEVS), state-approved vendor software and […]...
12. Department of Health Care Services (DHCS) will only accept the National Provider Identifier Providers are reminded that t he Department of Health Care Services (DHCS) will only accept the National Provider Identifier (NPI) on all Medi-Cal and Child Health and Disability Prevention (CHDP) program claims. This policy has been in effect since October 1, 2008. To ensure timely payment, pharmacies using the Medi-Cal POS NCPDP Pharmacy Transaction Specifications, […]...
13. PacifiCare Dental Plan, United HealthCare Providers Plan Review Regarding the PacifiCare Dental Insurance Plan (Region 1). This dental plan offers individual and family dental benefits. A family membership covers the head of household including spouse, your children 19 years of age or younger and your children up to age 23 if attending school full time. Your online request must be processed on or […]...