In CMS
May 3rd, 2019
Social determinants of health (SDOH). You’ve probably been hearing that term a lot lately. Karen DeSalvo, MD, MPH, MSc, spoke on social determinants at HEALTHCON in Las Vegas (April 28 – May 1); and the American Medical Association and UnitedHealthcare recently announced a collaboration to standardize data collection on SDOH with new ICD-10-CM codes. What ...
In Billing
Dec 14th, 2018
Follow billing guidelines to ensure proper payment for this incentive payment model. The Medicare Diabetes Prevention Program (MDPP) expanded model is a structured behavior change intervention that aims to prevent the onset of type 2 diabetes among Medicare beneficiaries with an indication of pre-diabetes. The clinical intervention consists of a minimum of 16 intensive “core” ...
In MACRA
Mar 22nd, 2017
Section 3021 of the Affordable Care Act gives the Center for Medicare and Medicaid Innovation (CMMI) the authority to test alternate payment models (APMs). The goals of these APMs are to reduce program expenditures while preserving or enhancing the quality of care for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) beneficiaries. Pediatric Alternative Payment ...
In CMS
Dec 21st, 2016
The Centers for Medicare & Medicaid Services (CMS) announced Dec. 20 several new Innovation Center models and an update to the Comprehensive Care for Joint Replacement Model. The new payment models will allow for a broader range of clinicians to qualify for a 5 percent incentive payment through the Advanced Alternative Payment Model (APM) track ...
In Billing
Aug 8th, 2016
For over three years, Primary Care Physician Robert Lamberts, MD, has not taken insurance payment from government or private carriers. Instead, he runs a direct primary care (DPC) practice, which charges patients a flat, monthly rate of $35-65 (depending on the patient’s age). The rate includes all care, and the practice charges no co-pays. You ...