Points of Interest 04/08/2014



Points of Interest

08/APRIL/2014

CMS to increase Medicare Advantage (MA) pay rate by 0.4%

 After an aggressive lobbying push from the insurance industry, the CMS announced Monday that it would increase the overall rate it pays Medicare Advantage plans by 0.4% in 2015, despite a proposed policy issued in February that signaled a 1.9% rate cut.

 Preventative vs. Diagnostic Services in the Affordable Care Act

 Under the Affordable Care Act, insurance plans now cover preventative care without patient cost sharing, i.e., without co-pays, co-insurance, or deductibles.  However, services that are not classified as preventative care are still subject to cost sharing. It is important for physicians and their staff to be able to differentiate between the two in order to avoid blindsiding patients and avoid experiencing a revenue loss.

 What Physicians Need to Know About Fraud and Abuse Prevention Updates

 On March 18, the Department of Health and Human Services, Office of the Inspector General's (OIG) "Compendium of Priority Recommendations" was released. The report addressed the top 25 unimplemented recommendations, which would serve to protect the integrity of HHS programs. For physicians, two areas are of particular note: fraud and abuse prevention and recovery audit contractors (RACs).

Five Things to Know About Medicare Advantage Plans

Of all the evolutions seen in senior healthcare over the past four decades, few have proved to be more significant than the changes in regulations in the 1970s that provided Medicare beneficiaries the freedom to opt out of traditional Medicare and instead receive healthcare benefits through private health plans. Today more than 14 million American seniors and individuals with disabilities — about 28 percent of the total Medicare population — are enrolled in Medicare Advantage (MA) plans.

 Five important things to know about Medicare Advantage:

·         Care coordination work

·         MA plans are driven to improve quality

·         MA plans are attractive to younger seniors

·         Enrollment happens all year round

·         We're all in this together

 

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• Procedures  – CPT, Category II and HCPCS codes
• Diagnoses codes (ICD-9-CM and ICD-10-CM)
• Converter of ICD9 to ICD10
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• Corrective Coding Initiative (CCI),
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