Organizations are welcome and encouraged to apply for and participate in one or more models. Applicants will be required to plan and implement quality assurance and improvement activities as a condition of participation in this initiative and participate in CMS quality monitoring. During the demonstration, CMS will carefully monitor the program to ensure improved clinical quality, patient experience, and outcomes of care throughout participation in the initiative. Applicants will be required to propose strong patient protections that preserve beneficiary choice in seeking care from the provider of their choice.
Video: Senator Harkin Addresses False Claims That Health Reform Will Hurt Medicare Recipients
CMS Holding of Institutional Provider 2012 Date
As the Centers for Medicare & Medicaid Services (CMS) implements calendar year 2012 changes, Medicare claims administration contractors will be holding some institutional provider claims containing 2012 services for up to the first 10 business days of January 2012 (i.e., Sunday, January 1, 2012, through Tuesday, January 17, 2012). Claims will be released as system testing is successfully completed, which we expect during that time frame.
Durable Medical Equipment and Medicare Fraud
The durable medical equipment industry has been the target of extensive scrutiny from federal investigators. Makers of wheelchairs, prosthetic limbs and other medical equipment were reimbursed for nearly $9 billion in 2010. Many of the companies seeking reimbursement had no prior experience with Medicare billing. Whether through unfamiliarity or intentional acts, many of these businesses found themselves facing punishment for their billing practices. Some had their billing rights revoked, while others were required to submit to prepayment claims review.
Upcoming Changes to the Medicare Program
Beginning January 1, 2012, all Part B withholdings and overpayments shown on the remittance advice with PLB adjustment reason code ‘WO’ and forwarding balances with provider level adjustment (PLB) reason code FB will no longer have the beneficiary’s Health Insurance Claim number (HICN) on the remittance advice alongside the financial control number (FCN). If your office submits claims with the Patient Account Number field completed, this field of the remittance advice will now contain the patient account number instead.
The Official Medicare Set Aside Blog And Information Resource: Top 10 MSP
Given that we are working within the risk management industry, it has been incredibly surprising that we have not seen more insurance solutions enter the MSP marketplace over the years. As big a disaster as the Coventry guaranteed MSA program turned out to be, the concept was headed in the right direction. Although all the issues not very well thought out, or that marketing and sales took precedence over legal, the core of the idea was still to insure the approval so that claims could be closed faster, thus ending the associated expenses of waiting for CMS. The problem there was in the unknown: the subjective and fluid nature of CMS’ idea of what it takes to protect Medicare’s interests. The review not being regulated made that proposition much riskier than the premiums inferred and hence the failure of the program. While there is one other plan that insured against the $1,000 per claim per day penalty for reporting noncompliance, a new policy that became available on 2011 is offering coverage for more of a comprehensive MSP compliance plan. Premiums are derived by the overall compliance plan and the number of reportable claims. Those with comprehensive and reliable reporting, conditional payment and MSA controls in place will pay significantly less in total premium, much like an employer’s premium is affected by its experience rating. The policy covers not just the reporting penalty but things like medical benefits for the claimant while MSP triggered disputes are resolved with CMS. I would anticipate this offering to become more popular in 2012 as people become more aware of the benefits of foregoing CMS approval and taking more control over of their MSP exposures.
As Predicted, Obama Administration Backs Off Medicare Anti
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Vermillion Shareholder Alleges Medicare Denying Over 80 Percent of OVA1 Reimbursement Claims
Digital RNA Sequencing Using Optimized, Single-Molecule Barcodes Shiroguchi, Jia et al., PNAS Harvard University’s X. Sunney Xie and his colleagues present what they call a “truly digital” RNA-seq approach. “Following reverse transcription, a large set of barcode sequences is added in excess, and nearly every cDNA molecule is uniquely labeled by random attachment of barcode sequences to both ends,” Xie et al. write. Post PCR, the researchers use paired-end deep sequencing to read the barcodes and cDNA sequences. “Rather than counting the number of reads, RNA abundance is measured based on the number of unique barcode sequences observed for a given cDNA sequence,” the authors add. This allowed them to count with “single-copy resolution despite sequence-dependent bias and PCR-amplification noise.” Overall, the Harvard group says its approach is “analogous to digital PCR but amendable to quantifying a whole transcriptome.”
Breast implant warnings in boom
“It is concerning. People not fully qualified can be putting implants in for medical reasons when it is not fully justified,” Prof Cooter said. “I hope that the Medicare codes are not being deliberately misused (to claim health reasons).”
Debunking claims about Medicaid
Among the findings of a study released late last year by the Center for Medicare and Medicaid Services was that 93% of parents with a child enrolled in Medicaid or CHIP were somewhat or very satisfied with the program. Moreover, the parent satisfaction rates were higher than those of parents whose children had private health insurance. Sixty-six percent of parents with children in Medicaid reported that they were very satisfied, compared to only 48% of parents whose children had private health insurance.