Part B Insider (Multispecialty) Coding Alert

Published on Wed Apr 27, 2011 PDF

Medicare officials would like to see Accountable Care Organizations help alleviate your problems with patients dually eligible for Medicare and Medicaid.

"'Dual eligibles' are among the most chronically ill and costly individuals enrolled in both the Medicare and Medicaid programs, with many having multiple chronic conditions and/or long-term care needs," CMS says in a new fact sheet on the population.

"More than half of Medicare-Medicaid enrollees have incomes below the poverty line compared with 8 percent of other Medicare beneficiaries. Forty three percent of Medicare-Medicaid enrollees have at least one mental or cognitive impairment, while 60 percent have multiple chronic conditions."

Medicare-Medicaid enrollees account for a disproportionately large share of expenditures in both programs, CMS points out. They comprise 16 percent of Medicare enrollees, yet 27 percent of Medicare spending in 2006. In Medicaid, they comprised only 15 percent of enrollees but represented 39 percent of Medicaid spending in 2007.

Among other new initiatives, establishing ACOs should help tackle this issue, CMS contends. ACOs "will work togetherto coordinate care for patients, and be paid for the quality of care they deliver across settings," the fact sheet says.

The sheet is at www.cms.gov/apps/media/press/factsheet.asp?Counter=3954.