Close Encounters Of The Camping Kind…
W55.52XA — Struck by raccoonnnL23.7 — Contact with poison ivynnT62.1X1A — Toxic effect of poisonous berries
VA Announces More Veterans May Seek Private Medical Services
It appears that the Veterans Administration will allow Veterans to seek care from private providers!
nWe need to look into how this will be done, to be prepared. n
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- How does a provider contract for this?
- Credentialing?
- Possible volume and where?
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nnUnder pressure to improve care, the Department of Veterans Affairs will allow more veterans to use private medical services to meet growing demands for healthcare, the department announced Saturday. Veterans Affairs Secretary Eric K. Shinseki said in a brief statement that as part of an expansion of services, veterans will be able to seek care at private clinics and hospitals in areas where the department’s capacity to expand is limited. In such situations, the VA “is increasing the care we acquire in the community through non-VA care,” Shinseki said.nnThe agency will provide more specifics on these options in the next few days, said Victoria Dillon, a department spokeswoman. It is unclear how much this service expansion will cost. The VA already spends about 10% of its budget on private care, which cost $4.8 billion last year. The new directive comes as Shinseki faces calls for his resignation amid allegations that VA employees have been covering up long wait times for medical care and falsified appointment records to hide the delays. A number of Republicans, at least two Democratic lawmakers and the commander of the American Legion have called for Shinseki to step down.nnTwenty-six VA facilities — including sites in Phoenix, San Antonio and Fort Collins, Colo. — are under federal investigation. Shinseki is expected to present President Obama a preliminary report on the facilities in the coming week. Rep. Jeff Miller (R-Fla.), chairman of the House Veterans’ Affairs Committee, said he was pleased by the policy change to allow private care, but thought it should have come earlier.nn”It appears the department is finally taking concrete steps to address the problem,” he said in a statement. He called the move “a welcome change from the department’s previous approach, which was to wait months for the results of yet another investigation into aa problem we already know exists.” Miller supports legislation that would let veterans turn to private care when the VA can’t meet their needs within 30 days.nnThe idea of increased private care has been embraced by some Republicans and Democrats as a possible response to the growing issue of shortcomings in the department’s care. Sen. John McCain (R-Ariz.) has embraced the idea, and House Minority Leader Nancy Pelosi (D-Calif.) has said she is open to it. Amid the allegations of treatment delays, the administration is scrambling to show a new responsiveness to criticism of how it handles the growing number of injured and ill veterans.n
nSource: www.latimes.como; Paul Richter; Richard Simon; May 24, 2014.
Notice of Material Change
Seems to be the Season for the Notice of Material Change!
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The health plans are required to send out a NOMC anytime there is a change that may affect provider compensation. nnTimes, must be a changing, as we are seeing an unprecedented number of NOMC notices.nnManaged care contracting is, increasingly, more about strategy than just rates, fee schedules and dates on a page. The health plans now have more competition: more plans, payment models and methodologies. They are also competing not just for the traditional employer business, but also for individuals. We (yes We – as you are a part of it, like it or not) are in a mad race to create and market plans that sound like PPO (with open networks) but are in reality very narrow networks with very specific patient cost share and steerage components.nnNavigation of these wild times requires strategy (both contracting strategy and billing know how)! Let us help you navigate the treacherous currents and eddies and help you be successful…after all it is a $2 Trillion industry, there is plenty of money, it’s just in different places than it used to be.n
It’s pool season, no diving in the shallow end…
S06.0X0A — Concussion without loss of consciousnessnnS01.01XA — Laceration of scalpnnW16.022A — Fall into swimming pool, striking bottom and causing injurynnY93.12 — Platform divingnnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2015 implementation date. Please don’t hesitate to contact us for all of your training and education needs!
May in Colorado…
L55.2 — Sunburn of third degreennY93.17 — Water skiingnnT33.531A — Frostbite of fingersnnY93.23 — Snow skiingnnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2015 implementation date. Please don’t hesitate to contact us for all of your training and education needs!
CMS Begins Restructuring Of Quality Improvement Program
The Centers for Medicare & Medicaid Services (CMS) has taken its first step toward improving its efforts to ensure the effectiveness, efficiency, economy, and quality of care quality for Medicare beneficiaries in through the Quality Improvement Organization (QIO) Program.nnLast week, the federal agency announced the selection of Livanta LLC and KePRO as Beneficiary and Family Centered Care (BFCC) would be responsible for the program’s case review and monitoring activities at a broader level than the traditional QIO activities taking place at a more local level.nnBetween them, the two BFCC QIOs will oversee five geographic areas — Livanta (Areas 1, 5), KePRO (Areas, 2–3) — of the United States and its territories:n
Area 1: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Puerto Rico, Rhode Island, Vermont, Virgin IslandsnArea 2: District of Columbia, Delaware, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West VirginianArea 3: Alabama, Arkansas, Colorado, Kentucky, Louisiana, Mississippi, Montana, North Dakota, New Mexico, Oklahoma, South Dakota, Tennessee, Texas, Utah, WyomingnArea 4: Iowa, Illinois, Indiana, Kansas, Michigan, Minnesota, Missouri, Nebraska, Ohio, WisconsinnArea 5: Alaska, Arizona, California, Hawaii, Idaho, Nevada, Oregon, Washington
nEstablished by statute in 1982, the Medicare Quality Improvement Program Program is currently in its earliest phase of transformation which CMS set in motion back in 2011 with the publishing of the 10th Statement of Work (SOW).nn“One of the most critical roles of CMS is to protect the quality and safety of care delivered to beneficiaries. Care needs to be patient-centered and directly engage patients, families, and caregivers,” Dr. Patrick Conway, Deputy Administrator for Innovation and Quality and CMS CMO, said in a public statement. “The quality of care review is essential to ensure care delivered to all beneficiaries meets professionally recognized standards.”n
nnThe next step for improving the QIO Program is expect to take place this July with the award of contracts to organizations responsible for working directly with providers and communities. Shortly thereafter, CMS will release its 11th SOW on August 1.n
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Source: www.EHRIntelligence.com; Kyle Murphy; May 13, 2014.
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