The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay, but since its enactment in 1986 has remained an unfunded mandate.
Further reading
https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/
Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys ask consumers and patients to report on and evaluate their experiences with health care. These surveys cover topics that are important to consumers and focus on aspects of quality that consumers are best qualified to assess, such as the communication skills of providers and ease of access to health care services. The acronym “CAHPS” is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
Further reading
https://www.ahrq.gov/cahps/about-cahps/index.html
Tom Meyer is the featured panelist for the upcoming Special Topic Webinar: 21st Century Cures Act on September 21st. RESERVE your seat today!
Medicaid Who’s Who: Tom Meyer – Chief Program Integrity Officer, HHAeXchange
1. What segment of the industry are you currently involved?
A: Software and services for the home care industry
2. How many years have you been in the Medicaid industry?
A: 11 ½ years
3. What is your focus/passion? (Industry related or not)
A: Creating efficient processes
4. What is the top item on your “bucket list?”
A: Touring the USA
5. What do you enjoy doing most with your personal time?
A: Cycling (think Tour de France, only slower)
6. Who is your favorite historical figure and why?
A: George Washington. Though he had many accomplishments, I most admire him for having voluntarily surrendered power (twice!)
7. What is your favorite junk food?
A: Chocolate
8. Of what accomplishment are you most proud?
A: My three daughters.
9. For what one thing do you wish you could get a mulligan?
A: My lame marriage proposal.
10. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months?
A: 1. The replacement or adjustments to ACA (Obamacare)
2. Value Based Payment Methodologies (and the data to support them)
3. Funding Levels
Tom Meyer is the featured panelist for the upcoming Special Topic Webinar: 21st Century Cures Act on September 21st. RESERVE your seat today!
Advance Beneficiary Notice – The ABN is a written notice you must issue to a Fee-For-Service beneficiary before furnishing items or services that are usually covered by Medicare but are not expected to be paid in a specific instance for certain reasons, such as lack of medical necessity. The ABN allows the beneficiary to make an informed decision about whether to get the item or service that may not be covered and accept financial responsibility if Medicare does not pay. If the beneficiary does not get written notice when it is required, he or she may not be held financially liable if Medicare denies payment, and you may be financially liable if Medicare does not pay. The ABN is used for Medicare Part B (outpatient) and Part A (limited to hospice, Home Health Agencies, and Religious Nonmedical Health Care Institutions only) items and services.
Further reading
https://www.medicare.gov/claims-and-appeals/medicare-rights/abn/advance-notice-of-noncoverage.html
Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2vdvt9S
For optimist readers- http://bit.ly/2v3Ugx6
CHECK FOR A PULSE- Looks like Obamacare lives to skyrocket premiums another day (for those of us who still pay premiums, anyway). The Senate’s Skinny Repeal got shot down 51-49, with John McCain helping nix it along with two other Republicans. The night came with high drama, including a call from Trump to McCain (with Pence handing him the phone). McConnel is reported to have said “its time to move on.” My prediction: its done (at least for a long time).
BAY STATE BUSINESSES SUPER EXCITED TO PAY $300M IN FEES TO FUND INCREASING MEDICAID COSTS- Your reward as an employer in MA for providing jobs? Paying your employees’ healthcare costs AND $2k per employee to cover any Medicaid bennies on your payroll. Best. Plan. Ever. It’s a wonderful thing for politicians that 99% of Americans hated high school econ. The Good Guvn’r Baker’s plan is being scaled back, but not dead yet. If you want a vision of the future, imagine a boot stamping on a human face – forever. (Orwell)
TAKING IT UP A NOTCH- You know all those wacky states trying to add work requirements for non-disabled, non-elderly Medicaid bennies? Well if Senator John Kennedy of LA (cool name, rings a bell) has his way, Federal Medicaid regs will be changed to require it nationwide. Put this one on your watch list.
I WILL GLADLY PAY YOU ON TUESDAY FOR A HAMBURGER TODAY – IL finally started to pay some of the MCO tab last week – $750M in back payments went to plans. Now only about $3.5B more to go to get square. Reality is that which, when you stop believing in it, doesn’t go away. (Philip K. Dick)
ARKANSAS TRYING TO RESTORE COVERAGE FOR 2,000 IMMIGRANT CHILDREN EXLCUDED FROM MEDICAID BY BILL CLINTON- AR has about 12,000 Marshallese (The Marshall Islands) who got in under a 1986 law. Thing is Bill Clinton’s welfare reform (yeah, he did that) nixed any Medicaid coverage for them. AR DHS submitted a proposal to undo the Clinton coverage ban this week for the kids.
FLICKERTAIL STATE WILL COVER ABA FOR AUTISM- North Dakota Medicaid will cover applied behavioral analysis (ABA) for autistic children as of this week. Attempts by state reps to mandate commercial insurers in the state cover it were unsuccessful.
FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Let’s start the ticker and see who wins this week’s award. Tammie Sensenig of Denver, PA was sentenced this week to 4 years in prison. She already had a Medicaid fraud conviction, but lied about it and forged a background check when she got a new job as a behavioral health consultant for a company that provides Medicaid services. PA paid out $84k to the already-barred provider. Bharat Patel’s case this week in Norwalk, CT included video of him writing scripts in exchange for cash. He’s accused of stealing $4M from Medicaid by selling scripts to addicts. Meridian Senior Living Group in NC is being prosecuted for a $60M Medicaid fraud, based on comparing staffing levels to billable hours (hint -there’s not enough staff and too many billable hours). Meridian you win this week’s award by a mile! Total taxpayer tab this week: $64.8M. There was a lot more in Medicare but we stick to Caid here!
I WILL BE AT MESC IN A FEW WEEKS, WILL YOU? If so send me a note and let’s meet up.
I WILL BE AT MHPA 2017 IN OCT., WILL YOU? You can check it out here – http://bit.ly/2twCi5L Every 100th registrant will get a free Medicaid Foundations Course registration (our online training course).
That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (It is nearly August and August is hot! Want to read Light in August with me? If 3 or more write in we’ll do a book club on it) and keep running the race (you know who you are).
FULL, FREE newsletter@ mostlymedicaid.com . News that didn’t make it and sources for those that did: twitter @mostlymedicaid . Trystero: Chichi wa sekai o sukuu tame ni musuko o okurimashita
American Association of Professional Coders – a professional association for people working in specific areas of administration within healthcare businesses in the United States.[5] AAPC is one of a number of providers who offer services such as certification and training to medical coders,[4] medical billers, auditors, compliance managers, and practice managers in the United States. Currently, AAPC has over 155,000 worldwide members,[6] of which nearly 108,000 are certified.
Further reading
Colorectal Cancer Screening – The percentage of members 50–75 years of age who had appropriate screening for colorectal cancer.
Further reading
Comprehensive Diabetes Care Medical Attention for Nephropathy.
Further reading
Comprehensive Diabetes Care Eye Exam – Eye exam (retinal) performed.
Further reading
https://hmsa.com/portal/provider/PRC_Guide_Comprehensive_Diabetes_Care_Eye_Exam.pdf
Comprehensive Diabetes Care A1c Testing – The percentage of members 18–75 years of age with diabetes (type 1 and type 2) who had each of the following:
• Hemoglobin A1c (HbA1c) testing.
• HbA1c poor control (>9.0%).
• HbA1c control (<8.0%).
Further reading
