Category: MAOTD (Medicaid Acronym of the Day)

Medicaid and CHIP Business Information Solutions – In 2010 CMS initiated the Medicaid and CHIP Business Information Solution (MACBIS) to meet mandates requiring reliable, comprehensive, and timely Medicaid and CHIP operational and programmatic data supported by leading edge technology and analytics solutions. MACBIS is an enterprise-wide initiative to ensure the Medicaid and CHIP data infrastructure and technology are commensurate to the programs’ role in evolving health care delivery reforms, access to coverage, and to enable proper monitoring and oversight. Aside from data needs to support the multi-billion dollar waiver negotiations, CMS will use MACBIS data for program integrity, evaluation of demonstrations, actuarial analysis, quality of care analysis, and to share this rich data set with states, stakeholders, and the research community.

MACBIS currently consists of four major projects: Medicaid and CHIP Program (MACPro), the Transformed Medicaid Statistical Information System (T-MSIS), the Medicaid Drug Rebate (MDR) program, the Medicaid and CHIP Financial program, the latter of which is the early planning in FY2017.

Further reading –

https://www.medicaid.gov/medicaid/data-and-systems/macbis/index.html

Medicare Advantage – You can get your Medicare benefits through Original Medicare, or a Medicare Advantage Plan (like an HMO or PPO). If you have Original Medicare, the government pays for Medicare benefits when you get them. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. Medicare pays these  companies to cover your Medicare benefits. If you join a Medicare Advantage Plan, the plan will provide all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage.

Further reading –

https://www.medicare.gov/Pubs/pdf/11474.pdf

Low-income Subsidy – Eligible beneficiaries who have limited income may qualify for a government program that helps pay for Medicare Part D prescription drug costs.

Medicare beneficiaries receiving the low-income subsidy (LIS) get assistance in paying for their Part D monthly premium, annual deductible, coinsurance, and copayments. Also, individuals enrolled in the Extra Help program do not have a gap in prescription drug coverage, also known as the coverage gap, or the Medicare “donut hole.” The amount of subsidy depends on the individual’s income compared to the Federal Poverty Level and resource limitations set by the Social Security Act.

Further reading –

https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8094.pdf

Kaiser Commission on Medicaid and the Uninsured – The Program on Medicaid and the Uninsured is the largest operating program of the Kaiser Family Foundation and serves as a key resource for policymakers, the media, and organizations seeking information on health care for the low-income population and the Medicaid program. Its work focuses on key health policy issues at the national and state level, including Medicaid and health reform, access to care, and health care financing for the low-income population. The Program provides timely, relevant and trusted information and analysis on health care coverage and access to care, the role of Medicaid and the Children’s Health Insurance Program, and coverage of the uninsured to inform policy discussions. The Program collects and analyzes policy and data at the state and federal level on eligibility and enrollment; spending, coverage, and care delivery; long term services and supports; and Medicaid’s role for high-need populations and dual eligible beneficiaries. The Program was formerly the Kaiser Commission on Medicaid and the Uninsured, chaired by James R. Tallon, Jr., with a bipartisan advisory group of national leaders and experts in health care and public policy from 1991-2016.

Further reading –

https://www.kff.org/medicaid/

Integrated Public Use Microdata Series – IPUMS USA collects, preserves and harmonizes U.S. census microdata and provides easy access to this data with enhanced documentation. Data includes decennial censuses from 1790 to 2010 and American Community Surveys (ACS) from 2000 to the present.

Further reading –

https://usa.ipums.org/usa/

Inpatient Prospective Payment System – Section 1886(d) of the Social Security Act (the Act) sets forth a system of payment for the operating costs of acute care hospital inpatient stays under Medicare Part A (Hospital Insurance) based on prospectively set rates. This payment system is referred to as the inpatient prospective payment system (IPPS). Under the IPPS, each case is categorized into a diagnosis-related group (DRG). Each DRG has a payment weight assigned to it, based on the average resources used to treat Medicare patients in that DRG.

Further reading –

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html

The Integrated Data Repository (IDR) is a high-volume data warehouse integrating Parts A, B, C, D, and DME claims, beneficiary and provider data sources, along with ancillary data such as contract information, risk scores, and many others. Access to this robust integrated data supports much needed analytics across CMS.

What benefits does IDR offer for business solutions?

Medical Trend & Utilization Analysis
Healthcare Cost & Assessment
Policy Analysis and Development
Provider Profiling & Management
Quality and Effectiveness: Pay for Performance
Program Integrity and Fraud, Waste & Abuse
Rapid response to legislative inquiries
Data available for claims-based program operational needs

The IDR offers even more than just integrated data:

State of the art business intelligence, reporting, and additional data access capabilities
Automated Finder File and Data Extract Process
Data dictionary, data limitations information, source to target mappings, etc.

Further reading –

https://www.cms.gov/Research-Statistics-Data-and-Systems/Research-Statistics-Data-and-Systems.html

International Classification of Diseases, 10th Edition – The National Center for Health Statistics (NCHS), the Federal agency responsible for use of the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) in the United States, has developed a clinical modification of the classification for morbidity purposes. The ICD-10 is used to code and classify mortality data from death certificates, having replaced ICD-9 for this purpose as of January 1, 1999. ICD-10-CM is the replacement for ICD-9-CM, volumes 1 and 2, effective October 1, 2015.

The ICD-10 is copyrighted by the World Health Organization (WHO), which owns and publishes the classification. WHO has authorized the development of an adaptation of ICD-10 for use in the United States for U.S. government purposes. As agreed, all modifications to the ICD-10 must conform to WHO conventions for the ICD. ICD-10-CM was developed following a thorough evaluation by a Technical Advisory Panel and extensive additional consultation with physician groups, clinical coders, and others to assure clinical accuracy and utility.

Further reading –

https://www.cdc.gov/nchs/icd/icd10cm.htm

Founded in 1944, the Health Research & Educational Trust (HRET) is the not-for-profit research and education affiliate of the American Hospital Association (AHA). HRET’s mission is to transform health care through research and education. HRET’s applied research seeks to create new knowledge, tools and assistance in improving the delivery of health care by providers and practitioners within the communities they serve.

Further reading –

http://www.hret.org/

 

Health Risk Assesment – The HRA includes questions about chronic diseases, injury risks, modifiable risk factors, and urgent health needs. An HRA generally asks about overall health and functional matters such as ability to engage in activities of daily living (ADLs), level of physical activity, history with regards to falling, any experience with pain, eating patterns, fatigue, alcohol or tobacco use, and medication use.

Further reading –

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/AWV_chart_ICN905706.pdf