Archive for June, 2011

News on Medicaid Personal Care Services

Tuesday, June 21st, 2011

According to a report by the Office of Inspector General (OIG) of the Department of Health & Human Services, taxpayers are paying for improper Medicaid claims for personal care services. Completed OIG work (as well as ongoing research) takes a hard look at Medicaid’s payment for these services around the country, with the two most recent reports related to audits looking at billing collections in Washington State and North Carolina. Additional reports will provide information for Nevada cities like Las Vegas and Henderson.

These audits recommend that Washington State and North Carolina refund over $61.1 million to the Federal Government. They also urge the Centers for Medicare & Medicaid Services (CMS) to review an additional $30.0 million in tax dollars that are possibly unallowable.

Personal care services are nonmedical services provided to help with daily activities like dressing, bathing, light housework, meal preparation, medication management and transportation. One single illness or accident can make it necessary for anyone to require assistance for these everyday activities, which is why correct medical revenue collecting is so important.

What You Need to Know About ACOs

Thursday, June 16th, 2011

ACOs are a current buzzword when it comes to health policy and in the integrated medical care field, but do you know what they are? Read our post for how it may affect Las Vegas billing for medical services and more.

The goal of ACOs (Accountable Care Organizations) is to:

• Pay providers in a way that encourages them to work collaboratively.

• Pay providers in a way that doesn’t spurn supplier induced demand.

• Create an organization that reaps benefits from providing high quality care.

What are the differences between ACOs and HMOs?

• Accountability lies with providers, so providers (as opposed to insurance companies) are evaluated based on quality and efficiency of care.

• A health plan intermediary is not required for direct contracting with provider organizations.

• Flexibility in the type of organization is allowed with ACOs. For example, some regions may prefer a physician-hospital organization (PHO), while others may prefer independent practice associations (IPAs).

How Telehealth Helps Docs Help the Underserved

Wednesday, June 15th, 2011

A new study published in the June 2 online issue of the New England Journal of Medicine and the June 9 print edition reveals that telehealth can help doctors help the underserved. Researchers at the University of New Mexico Health Sciences Center (UNMHSC) developed a model called Extension for Community Healthcare Outcomes (ECHO) to bring effective treatment to those with the Hepatitis C virus (HCV) infection in underserved areas by providing state-of-the-art medical knowledge to primary care providers and nurses.

Community-based medical teams (including physicians and nurses) participated in weekly clinics with specialists using videoconference or teleconference lines. They jointly discussed patients’ medical history, reviewed lab results and other findings and collaborated on treatment plans using evidence-based treatment approaches.

After studying outcomes for 407 patients undergoing treatment for HCV infection at 21 community settings, they found that the HCV infection was cured at a similar rate for patients treated at these community-based settings as patients treated at the university clinic.

Although treatment for HCV is available and effective, it has been known to cause serious side effects and has to be managed by a medical team as a result. Surgical scheduling, care and treatment aren’t available outside of university medical centers in Las Vegas, which makes Project ECHO so important.

Another important factor is that because most of the patients at the community setting were Hispanic, the study also increased treatment for underserved and minority patients. AHRQ’s 2010 National Healthcare Quality Report (released in February) revealed that Hispanics had worse access to integrated medical care and health services.

No Significant Savings from Medicare ACO Test Results

Monday, June 13th, 2011

Results from a government experiment intended to lower costs and coordinate care for Medicare patients reveal no significant savings. The test, which lasted five years, recruited 10 leading health systems and offered financial bonuses if they provided older patients with efficient, high-quality care.

According to an official evaluation (which has yet to be published), in the final year, 2010, just four of the 10 well-established groups run by doctors reduced their Medicare spending enough to qualify for a bonus. The evaluation shows that two saved enough when collecting on medical bills to get bonuses in all five years, while three didn’t succeed even once.
The patchy results are significant because they involve ACOs (accountable care organizations), which are very trendy in health policy and were also included in the year-old federal law meant to overhaul the nation’s health-care system. A twist on the old concept of managed care, the law calls for the Medicare program to approve teams of doctors or hospitals to run such organizations beginning in January. Important details aside, the basic outline and new ACOs are as follows: Medicare shares savings with health organizations if they can reach specific hallmarks of quality while treating older people for less money.

Recent studies have shown that when a medical group becomes an ACO it can lose money—at least for the first few years—due to the financial investments made in record-keeping and other changes predicted by the government. Stay tuned for more on this story and other integrated medical care news in Henderson.

What You Need to Know About E-Prescribing

Wednesday, June 8th, 2011

Want to stay current on the latest news when it comes to e-prescribing and everything else in the medical billing world? You have come to the right place! Las Vegas’ Integrated Medical Management has all of the latest news, including news about e-prescribing.

According to recent reports, physicians seeing Medicare patients now have additional opportunities to avoid being penalized for failing to prescribe medications electronically by the June 30 deadline, issued under a proposed rule via the Centers for Medicare & Medicaid Services. This is welcome news for eligible physicians who don’t expect to report at least 10 electronic drug orders to CMS by June 30.
Medicare will reprimand those doctors that don’t meet 2011 e-prescribing requirements by reducing payments by 1% in 2012 and said on May 26 that doctors would be given a second chance to avoid the penalty post-deadline. Said physicians are allowed to claim one of the hardship exemptions online through October 1.

Additionally, the proposed rule would apply to physician practices that have already adopted certified electronic medical record systems—which could be used to satisfy the e-prescribing requirements, too—in an effort to earn Medicare or Medicaid meaningful use bonuses. Practices that use certified EMRs to send paperless drug orders will satisfy the e-prescribing requirement under the current program, as long as the system meets four functionalities. EMRs will be acceptable for e-prescribing in future reporting years (even if they don’t meet the four specific functionalities) if the proposed rule is finalized later this year.

“Eliminating unreasonable penalties and burdensome requirements, and providing physicians with more flexibility through an exemption process, will help ensure more physicians are able to successfully participate in the e-prescribing incentive program. The AMA has continually stressed to CMS that these changes were essential and is pleased to see them become a reality in a rule that will be finalized later this summer,” said AMA president Cecil B. Wilson, MD.