Managed Care Organizational Self- Assessment: Aggregate Results
|
|
|
- Shanon Cooper
- 5 years ago
- Views:
Transcription
1 Managed Care Organizational Self- Assessment: Aggregate Results November 29 th 2018 NY Alliance Leadership Conference The Managed Care Community of Practice is a project of the New York Alliance for Inclusion & Innovation in partnership with the following organizations 1
2 Presentation Overview I. Managed Care Organizational Self-Assessment Aggregate Results II. Agency Benchmark Report III. Upcoming Events 2
3 Managed Care Organizational Self- Assessment Aggregate Results 3
4 Managed Care Organizational Self- Assessment This Managed Care Organizational Self- Assessment is designed to provide organizations with 11 domains of processes, practices and change management activities needed to effectively prepare for and function during the early stages of a business relationship with a Managed Care organization. The self-assessment tool offers a snapshot of the organization s current level of readiness as well as an assessment of the need for technical assistance. This tool may be helpful as a planning resource to guide organizations in their preparation and decision making activities. 4
5 Important Information to Know Each agency submitted a survey based on selfreport The benchmarking tool is based on scores relative to agencies that completed the assessment. Agencies that have not submitted the assessment may differ in significant ways. 20 agencies reported that this survey did not apply to their contexts. 5
6 Demographic Information 241 completed Managed Care Organizational Self-Assessments were included in analysis The agencies who responded (n=241) were distributed across 13 different regions in New York State. Of these, 134 (55.6%) were already holding contracts with one or more Managed Care Organizations. Only 13 agencies (5.4%) reported that more than 50% of their reimbursement came from Managed Care. 6
7 MC OSA Domain Scores DOMAIN N POSSIBLE RANGE MEAN Understanding MCO MCO Contracting Communication IT Systems* UM Practices Member Services Interface with other providers Quality Management Finance & Billing Access Requirements Data Evaluation * reflects a lower N because 55 agencies did not have an EHR/ EMR IT system. 7
8 Domain Scores: NYC vs. Rest Of State DOMAIN N NYC MEAN N ROS MEAN Understanding MCO MCO Contracting Communication* IT Systems UM Practices* Member Services Interface with other providers Quality Management Finance & Billing* Access Requirements* Data Evaluation reflects a lower N because 55 agencies did not have an EHR/ EMR IT system. * marks statistically significant difference 8
9 IT Systems IT Systems Capacity Currently uses an EHR Currently do not use an EHR/EMR Capable of billing multiple MCOs via EHR Currently bills MCOs in EHR N % % 55 23% % 75 31% 9
10 Reported Capacity of EHR/EMR Systems 10
11 Percentage of Reimbursement from Managed Care Plans Reimbursement Number Percent Less than 10% % % % More than 75% Unsure
12 Client Insurance/Coverage Client Insurance Type Range Mean Percentages (SD) Medicaid only (FFS) (34.8) Medicaid & Medicare (25.5) Medicaid Managed (18.7) Care Third party (15.0) Commercial Insurance (8.8) Self-Pay (9.39 Medicare Only (8.7) Medicare Managed Care (1.1) 12
13 Verification of Eligibility E Paces Calling MCO Other Batch Upload Do not verify Verifone
14 Feedback on Concerns Reasons for Concern N % Billing % Staff/other resources % Financial Viability % Quality of services % Data Collection/ Outcome % Measures Lack of experience/ % information Training/Educational Support % IT/Software % EHR and systems % Cultural shift % 14
15 Benchmark Report 18
16 Regional Learning Collaboratives ACTIVITY Regional Learning Collaborative: Rochester Regional Learning Collaborative: Albany Regional Learning Collaborative: NYC DATE December 10 th December 11 th December 14 th Register today at 16
17 Questions & Discussion us at 17
Managed Care Lessons Learned THE PROVIDER'S PERSPECTIVE
Managed Care Lessons Learned THE PROVIDER'S PERSPECTIVE June 7, 2016 Presenters Meg Baier, TAC Project Manager, ICL/MCTAC Chris Copeland, Chief Operating Office, ICL Noah Isaacs, Managed Care Project Manager,
Managed Care Readiness Training Series: Revenue Cycle Management 3 rd Learning Community Claim Submission and Payer follow-up
Managed Care Readiness Training Series: Revenue Cycle Management 3 rd Learning Community Claim Submission and Payer follow-up Claim Submission and Payer follow-up Presenter: David Wawrzynek MS, MBA Managed
Managed Care Contracting The Plan Perspective
Managed Care Contracting The Plan Perspective Harold Iselin, Greenberg Traurig Whitney M. Phelps, Greenberg Traurig Andrew Cleek, PsyD, McSilver Institute Dan Ferris, MPA, McSilver Institute MCTAC.info@nyu.edu
CHCS. Technical Assistance. Tool. Implementing the Medicaid Primary Care Rate. Increase: A Roadmap for States. Center for Health Care Strategies, Inc.
CHCS Center for Health Care Strategies, Inc. Implementing the Medicaid Primary Care Rate Increase: A Roadmap for States Technical Assistance Tool N OVEMBER 2011 T he Affordable Care Act s (ACA) expansion
No change from proposed rule. healthcare providers and suppliers of services (e.g.,
American College of Physicians Medicare Shared Savings/Accountable Care Organization (ACO) Final Rule Summary Analysis Category Final Rule Summary Change from Proposed Rule and Comments ACO refers to a
Gulf Coast and LA HFMA Payer Summit Value-based contracts same healthcare business?
Gulf Coast and LA HFMA Payer Summit Value-based contracts same healthcare business? Richard R. Vath, MD FMOLHS SVP/Chief Clinical Transformation Officer President Health Leaders Network and Medicare ACO
2019 Merit-based Incentive Payment System (MIPS) Quality Performance Category: Medicare Part B Claims Data Submission Fact Sheet
2019 Merit-based Incentive Payment System (MIPS) Quality Performance Category: Medicare Part B Claims Data Submission Fact Sheet The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the
Adult BH HCBS Infrastructure Proposal: Application Walk Through. Webinar by OMH & OASAS, hosted by MCTAC, 05/23/18
Adult BH HCBS Infrastructure Proposal: Application Walk Through Webinar by OMH & OASAS, hosted by MCTAC, 05/23/18 May 24, 2018 2 Webinar Agenda Overview: New State Initiatives to Increase Adult BH HCBS
Medicare s Shared Savings Program: Accountable Care Organizations Proposed Rule
Medicare s Shared Savings Program: Accountable Care Organizations Proposed Rule On March 31, 2011, the Centers for Medicare and Medicaid Services (CMS) issued its proposed rule on Medicare s Shared Savings
The New York State Value-Based Payment (VBP) Roadmap. Behavioral Health Providers January 30, 2018
The New York State Value-Based Payment (VBP) Roadmap Behavioral Health Providers January 30, 2018 1 Housekeeping All lines have been muted To ask a question at any time, use the Chat feature in WebEx We
The ACO Effort: A Status Report
1 The ACO Effort: A Status Report J. Mark Waxman mwaxman@foley.com 617-342-4055 2 Whats the fuss about? A need for accountability for cost and quality A belief that the system can improve if: Provider
ACO Essentials Series
ACO Essentials Series How to Use Health Endeavors Technology January, 2017 1/11/2017 1 Agenda Day 1&2 Interactive Analytic Tools Define ACO Goals- Success Plan Organizational Structure Executive TIN and
2012 Poll Survey of Health Insurance Market
2012 Poll Survey of Health Insurance Market Enclosed is a summary of results of a poll survey provided to consumers of healthcare and health insurance as well as healthcare providers and insurance professionals.
Implementing the DSRIP Finance Function
Implementing the DSRIP Finance Function DSRIP Support Team February 27, 2015 February 2015 2 Contents Developing the DSRIP Finance Function Defining The Vision Responsibilities/Structural Considerations
Aligning PQRS and Meaningful Use. Maximize your Medicare Reimbursement
Aligning PQRS and Meaningful Use Maximize your Medicare Reimbursement INTRODUCTION Brux McClellan, MPH, MHA Project Coordinator, HealthInsight Payment Adjustments Incentive $$ & Payment Adjustments Value
MACRA and Medicare Advantage
MACRA and Medicare Advantage Lynn Dong, FSA, MAAA Christopher Kunkel, FSA, MAAA, PhD April 6, 2017 Caveats and limitations This presentation and question and answer session is not intended to be an actuarial
How are the State, Managed Medicaid Organizations and Providers Preparing for Medicaid Value-Based Payments?
How are the State, Managed Medicaid Organizations and Providers Preparing for Medicaid Value-Based Payments? 1:10 PM 2:10 PM Steering Toward Success: Achieving Value in Whole Person Care September 25 and
Current Status Of Legislation on Quality Bench Marks
Conflicts of Interest Current Status Of Legislation on Quality Bench Marks None Sean P. Roddy, MD Albany, NY Reason For Quality Measures Progressive increase in healthcare costs under the fee-for-service
ACOs/Shared Savings Demonstration Project: What Does It All Mean?
ACOs/Shared Savings Demonstration Project: What Does It All Mean? None Conflicts of Interest Sean P. Roddy, MD Albany, NY Accountable Care Organizations Term introduced in 2006 by Fisher et al. the hospital
Medicaid Managed Care Network Providers & Medicaid Provider Enrollment. December 20, 2017
Medicaid Managed Care Network Providers & Medicaid Provider Enrollment December 20, 2017 2 MCO outreach efforts Enrollments Terminations Questions 3 MCO Outreach Efforts Based on survey responses, all
Understanding and Facilitating Rural Health Transformation
Understanding and Facilitating Rural Health Transformation 2017 Center for Rural Health Annual Meeting St. Simons Island, Georgia August 16, 2017 A. Clinton MacKinney, MD, MS Clinical Associate Professor
Exchanges and Medicaid:
Exchanges and Medicaid: Key Issues for Implementing the ACA Anne K. Gauthier Senior Program Director National Academy for State Health Policy The 18 th Princeton Conference: Where Do We Go From Here: The
HealthChoice Illinois
HealthChoice Illinois November 2017 Presented by: Matt Wolf and Lori Lomahan Meeting Agenda Introductions Credentialing Update Billing Instructions Claims Adjudication Reimbursement Methodology MCO Website
A Guide to Submitting Medicaid Requests for Other Payer Advanced APM Determinations (Payer Initiated Submission Form)
A Guide to Submitting Medicaid Requests for Other Payer Advanced APM Determinations (Payer Initiated Submission Form) Purpose Through the Payer Initiated Submission Form (the Form ), the Centers for Medicare
Today s Payers and Providers
Today s Payers and Providers Strategies for Success Emad Rizk, MD President and Chief Executive Officer Accretive Health Session Objectives Description of value based models in the market Data elements
The Physician Value-Based Payment Modifier under the 2014 Medicare Physician Fee Schedule. December 3, 2013
The Physician Value-Based Payment Modifier under the 2014 Medicare Physician Fee Schedule December 3, 2013 Medicare Learning Network This MLN Connects National Provider Call (MLN Connects Call) is part
Value-Based Payments (VBP)
Value-Based Payments (VBP) Overview September 27, 2016 September 27, 2016 2 NYS What is Value Based Payment? NYS Timeline VBP Outcomes and Levels P4P vs. VBP VBP Overview Agenda MCTAC VBP Arrangements
Value Based Payment 101
Value Based Payment 101 NewYork Presbyterian & NewYork-Presbyterian Queens PPS Network Education Primary Care Providers 02.13.2018 Outline Value Based Payment (VBP) 1. Introductions & Welcome 2. National
Population-Based Healthcare: Structural Models and Options
Population-Based Healthcare: Structural Models and Options George Choriatis, Esq. Rivkin Radler LLP Presented at: Annual Fall Meeting New York State Bar Association Health Law Section Albany, New York
MACRA: THE FINAL RULE. Last updated 12/13/16
MACRA: THE FINAL RULE Last updated 12/13/16 1 Background April 2015 MACRA (Medicare Access & CHIP Reauthorization Act) is signed into law to repeal the sustainable growth rate (SGR) which drastically cut
Developing a Community Health Center Capital Project Plan and Budget - Part Two
Developing a Community Health Center Capital Project Plan and Budget - Part Two Jonathan Chapman Director, CHC Advisory Services June 27, 2018 1 Capital Link Launched in 1995, nonprofit, HRSA national
E-Commerce Enrollment
Electronic Claims Submission HCIQ will electronically submit your primary carrier, professional claims. Please refer to our payer list to view the insurance companies that we currently submit to. Electronic
CHOC Health Alliance Downstream Provider Notice CLAIMS SETTLEMENT PRACTICES & DISPUTE RESOLUTION MECHANISM
CHOC Health Alliance Downstream Provider Notice CLAIMS SETTLEMENT PRACTICES & DISPUTE RESOLUTION MECHANISM As required by Assembly Bill 1455, the California Department of Managed Health Care has set forth
Developing Billing Excellence. Presenter: Andrea Dickhaut, RDH, BSDH, MHA, Practice Administrator, DentaQuest Oral Health Center
Developing Billing Excellence Presenter: Andrea Dickhaut, RDH, BSDH, MHA, Practice Administrator, DentaQuest Oral Health Center DentaQuest Oral Health Center Multi-specialty group practice NOT a safety
New Opportunities, With ACA & QHI Support
New Opportunities, With ACA & QHI Support Philip Gaziano, MD April 5 th, 2012 ACA & QHI Introductions: QHI (an IT and Data company) Physician Owned and Run, and Founded in 2003 Owners and leaders Include:
Ready, Set, Go! The Readiness Review Process for Care Coordination and Provider Network Adequacy in Tennessee
Spotlight AARP Public Policy Institute Ready, Set, Go! The Readiness Review Process for Care Coordination and Provider Network Adequacy Lynda Flowers AARP Public Policy Institute This case study summary
Managed Provider Relations Overview
Managed Provider Relations Overview Geralyn D. Molinari Director, Managed Provider Relations Unit Office of Managed Health Care Division of Medical Assistance and Health Services Department of Human Services
The Four Knows and Tips of Contracting with Managed Care Organizations October 7, 2012
The Four Knows and Tips of Contracting with Managed Care Organizations October 7, 2012 The Four Knows of Contracting 1. Know the Rules 2. Know What the MCOs Need/Want? 3. Provider Know Thyself 4. Know
The Health Management Academy Strategic Survey Q1 2019: Defining Risk. March 2019
The Health Management Academy Strategic Survey Q1 2019: Defining Risk March 2019 1 Defining Risk In 2019, the U.S. healthcare market is poised to continue its march towards value-based care. In the context
Integrating Population Health Analytics and the EHR Environment Session 87, March 6, 2018
Integrating Population Health Analytics and the EHR Environment Session 87, March 6, 2018 Nina M. Taggart, MD, Senior Medical Director, Population Health and Payer Relations, Lehigh Valley Health Network
Best Practices for 340B Internal Audits and Key Takeaways from the Winter 340B Coalition Conference
Best Practices for 340B Internal Audits and Key Takeaways from the Winter 340B Coalition Conference February 9, 2017 1 Webinar Panelists! The Panel! Tammy Zukowski, MBA! Douglas E. Miller, Pharm.D.! William
Society of Professors of Child and Adolescent Psychiatry. Michael Jellinek, M.D. May 9, 2013
Society of Professors of Child and Adolescent Psychiatry Michael Jellinek, M.D. May 9, 2013 Health Care Reform: Drivers Extend Coverage (Social justice and efficiency) Cost (versus public acceptance, politics)
A Practical Discussion of Value and Quality Based Payments What Do I Do Now?
Emerging Challenges in Primary Care: 2016 A Practical Discussion of Value and Quality Based Payments What Do I Do Now? Modified from AHLA Physicians and Hospitals Law Institute 2016 Faculty Ellie Bane
Area Agency on Aging Directors, Area Agency on Aging Association of Michigan, MDSA, Disability Networks, MMAP, Inc.
DATE: October 25, 2017 TO: FROM: Area Agency on Aging Directors, Area Agency on Aging Association of Michigan, MDSA, Disability Networks, MMAP, Inc. Richard Kline, Senior Deputy Director SUBJECT: Revised
Sixth Annual Transamerica Center for Health Studies Employers Survey: U.S. Businesses Remain Committed to Employee Healthcare Benefits
Sixth Annual Transamerica Center for Health Studies Employers Survey: U.S. Businesses Remain Committed to Employee Healthcare Benefits November 2018 1 Table of Contents About the Transamerica Center for
Behavioral Health Value Based Payment Readiness
Behavioral Health Value Based Payment Readiness Key Considerations for Participation in Independent Practice Associations (IPAs) and Behavioral Health Care Collaboratives (BHCCs) June 1, 2017 LLP Agenda
Medicaid Payment and Delivery System Innovation: Minnesota s Experience
Medicaid Payment and Delivery System Innovation: Minnesota s Experience MARIE ZIMMERMAN, MEDICAID DIRECTOR MINNESOTA DEPARTMENT OF HUMAN SERVICES MILBANK RSG 2015 Health Reforms in Minnesota MNSure (state
REGIONAL PLANNING CONSORTIUMS CAPITAL REGION OCTOBER STAKEHOLDER MEETING
REGIONAL PLANNING CONSORTIUMS CAPITAL REGION OCTOBER STAKEHOLDER MEETING REGIONAL PLANNING CONSORTIUMS GOALS FOR THIS MEETING Update on Medicaid Managed Care Implementation Review the Regional Planning
Managed LTC in Wisconsin. Procurement, Contracting and Rate Setting.
Managed LTC in Wisconsin Procurement, Contracting and Rate Setting http://www.dhs.wisconsin.gov/ltcare/index.htm Choices for people with long-term care needs Fee-For-Service LTC Family Care Managed LTC
Financial and Operational Benchmarking Trends & Techniques
Financial and Operational Benchmarking Trends & Techniques Susan Petrie Chief Operating Officer October 31, 2018 1 Capital Link - Overview Launched in 1995, nonprofit, HRSA national cooperative agreement
Becoming an In-Network Provider: The Health Department Perspective
Becoming an In-Network Provider: The Health Department Perspective November 18, 2013 Speakers: Scott Coley, MS, MPH, Immunization Billing Coordinator, New York State Department of Health Robin Iszler,
Session 75 OF, Advantages & Challenges for Provider Led Health Plans. Moderator: LuCretia Leola Hydell, ASA, MAAA
Session 75 OF, Advantages & Challenges for Provider Led Health Plans Moderator: LuCretia Leola Hydell, ASA, MAAA Presenters: Jerry Clark, MD, FACP Josh Martin Mark Rishell SOA Antitrust Disclaimer SOA
1 / 9. Remote Viewing Access to Electronically Filed Cases in the NH Circuit Court and NH Superior Court. SurveyMonkey. Answered: 19 Skipped: 0 1-5
Q Currently, electronic filing is available in the Circuit Court in Small Claims, Guardianship, and Estates. How many of these cases have you electronically initiated or filed into? Answered: 9 Skipped:
University of Maine System and Component Units. Core Financial Ratios and Composite Financial Index. FY10 and FY11
University of Maine System Office of Finance and Treasurer January 2012 TABLE OF CONTENTS Page Introduction 1 Component Units 1 Primary Reserve Ratio 2 Net Operating Revenues Ratio 3 Return on Net Assets
NY DSRIP PAM Assessment 2015
NY DSRIP PAM Assessment 2015 Table of Contents Introduction... 2 Performance and Payment Methodology... 2 Timeline... 4 PAM Administration... 4 Results Submission... 6 PAM Data Sharing Privacy Policy...
New York State Behavioral Health Medicaid Managed Care Contracting Overview.
New York State Behavioral Health Medicaid Managed Care Contracting Overview Adam Falcone, JD, MPH, Feldesman, Tucker, Leifer & Fidell Andrew Cleek, PsyD, McSilver Institute Meaghan Baier, LMSW, Institute
2019 ADVANCE NOTICE: CHANGES TO MEDICARE ADVANTAGE PAYMENT METHODOLOGY AND THE POTENTIAL EFFECT ON MEDICARE ADVANTAGE ORGANIZATIONS
February 6, 2014 GLENN GIESE FSA, MAAA KELLY BACKES FSA, MAAA 2019 ADVANCE NOTICE: CHANGES TO MEDICARE ADVANTAGE PAYMENT METHODOLOGY AND THE POTENTIAL EFFECT ON MEDICARE ADVANTAGE ORGANIZATIONS February
2013 Physician Quality Reporting System (PQRS): 2015 PQRS Payment Adjustment
June 2013 2013 Physician Quality Reporting System (PQRS): 2015 PQRS Payment Adjustment Background Section 1848(a)(8) of the Social Security Act, requires the Centers for Medicare & Medicaid Services (CMS)
National Health Policy Forum April 28, 2005 Sally Burner CMS
Understanding Medicare Advantage Bidding and Payment: Effects on Plan Choice and Beneficiary Premiums National Health Policy Forum April 28, 2005 Sally Burner CMS MA Bidding and Payment Pre-2006 payment
Fifth Annual Transamerica Center for Health Studies Survey: Employers Hold Steady in Time of Uncertainty
Fifth Annual Transamerica Center for Health Studies Survey: Employers Hold Steady in Time of Uncertainty November 2017 Table of Contents About the Transamerica Center for Health Studies Page 3 About the
University of Maine System and Component Units. Core Financial Ratios and Composite Financial Index. FY10 to FY12
University of Maine System Office of Finance and Treasurer January 2013 TABLE OF CONTENTS Page Introduction 1 Component Units 1 Primary Reserve Ratio 2 Net Operating Revenues Ratio 3 Return on Net Assets
Goals of the Program: Serve more people in their homes and communities Integrate physical health and long term Medicare and Medicaid services Enhance
Goals of the Program: Serve more people in their homes and communities Integrate physical health and long term Medicare and Medicaid services Enhance fiscal accountability Promote quality and innovation
Ethel Owen - Administrator Arthritis & Rheumatology Associates of Palm Beach, Inc. West Palm Beach, FL
Ethel Owen - Administrator Arthritis & Rheumatology Associates of Palm Beach, Inc. West Palm Beach, FL Practice Structure Office Management Physician Encounter Billing Office Physicians & Administrator
Health Reform: Where Are We Now?
Health Reform: Where Are We Now? Andrew Croshaw President, Leavitt Partners Consulting Geologic tectonic forces create our current landscape 2 November 13, 1963 South of Iceland 3 A new landscape emerges
Meeting Title. Facilitator. Dial +1 (646) join/ Conference Line. Alan Wengrofsky (Community Healthcare Network)
DSRIP Meeting Agenda Date and Time 9/11/15, 3-4PM Meeting Title NYP PPS Committee Location Milstein 1HN-151 Facilitator Jay Gormley, Robert Guimento, Brian Kurz Go to Meeting https://global.gotomeeting.com/
HIV Medical Clinics Health Reform Webinar: Preparing for 2014
HIV Medical Clinics Health Reform Webinar: Preparing for 2014 May 16, 2013 Julia Hidalgo, ScD, MSW, MPH Positive Outcomes, Inc. & George Washington University Julia.hidalgo@positiveoutcomes.net Download
2010 HEALTHCARE STRATEGY GROUP
2010 HEALTHCARE STRATEGY GROUP Contents Foreword 3 CH. 1 Executive Summary 5 CH. 2 Contracting with CMS 8 Contract Terms 8 Application Notes 8 Contract Termination Causes 10 CH. 3 ACO Structure, Providers
CY 2014 Physician Quality Reporting System (PQRS)
CY 2014 Physician Quality Reporting System (PQRS) 101 Table of Contents Step 1: Understand PQRS and how it impacts you A. When was PQRS first established and implemented? B. What is PQRS? C. How does CMS
Company New Application Checklist Agency Requirements NEW YORK EXEMPT MORTGAGE BROKER REGISTRATION-NP
Company New Application Checklist Agency Requirements Instructions This document includes instructions for a Not-for-Profit Organization (herein after referred to as nonprofit organization or organization
Executive Steering Committee Medicaid Eligibility System Project. October 24, 2014
Executive Steering Committee Medicaid Eligibility System Project October 24, 2014 Minutes -2- Federal Partner Update -3- Account Transfers Federally Facilitated Marketplace (FFM) As of October 20, 249,417
Medicaid Redesign Initiatives
Medicaid Redesign Initiatives Dan Heim Executive Vice President LeadingAge New York September 12, 2013 1 Agenda Medicaid Spending/Global Cap MRT Waiver Amendment FIDA Demonstration Balancing Incentive
R E A L I Z I N G T H E V A L U E I N V A L U E - B A S E D P U R C H A S I N G O F L T S S
R E A L I Z I N G T H E V A L U E I N V A L U E - B A S E D P U R C H A S I N G O F L T S S B R I D G I N G T H E G A P B E T W E E N T H E O R Y A N D A P P L I C A T I O N AUGUST 2017 Robert Butler,
Are You Optimizing Your Provider-Sponsored Medicare Advantage Plan?
Are You Optimizing Your Provider-Sponsored Medicare Advantage Plan? April 2016 WRITTEN BY: TYRONNE JOLLY, RICH TREMBOWICZ The Medicare market is swelling as the nation s aging population continues to grow.
STATE OF NEW JERSEY. Department of Banking and Insurance. Certified Organized Delivery System (ODS) Annual Report
STATE OF NEW JERSEY Department of Banking and Insurance Certified Organized Delivery System (ODS) Annual Report Name of ODS December 31, 2017 Year Ending This report may be submitted to the Department
2016 ADVANCE NOTICE: CHANGES TO MEDICARE ADVANTAGE PAYMENT METHODOLOGY AND THE POTENTIAL EFFECT ON MEDICARE ADVANTAGE ORGANIZATIONS AND BENEFICIARIES
February 6, 2014 GLENN GIESE FSA, MAAA KELLY BACKES FSA, MAAA 2016 ADVANCE NOTICE: CHANGES TO MEDICARE ADVANTAGE PAYMENT METHODOLOGY AND THE POTENTIAL EFFECT ON MEDICARE ADVANTAGE ORGANIZATIONS AND BENEFICIARIES
ARRA Medicare and Medicaid Incentive Payments: How will Tribal Health Programs fit in?
NPAIHB POLICY BRIEF ARRA Medicare & Medicaid Incentive Payments PREPARED BY: NORTHWEST PORTLAND AREA INDIAN HEALTH BOARD Issue No.03, February 11, 2010 ARRA Medicare and Medicaid Incentive Payments: How
HHUNY Guidance Document: Member Medicaid Eligibility & Status
HHUNY Guidance Document: Member Medicaid Eligibility & Status Version 1: March 16, 2017 1 P a g e A member must be Medicaid active in order to qualify for Health Home services on a monthly basis. There
MassHealth Section 1115 Waiver Summary. Key provisions:
MassHealth Section 1115 Waiver Summary With unsustainable spending growth that accounts for nearly 40 percent of the overall state budget, MassHealth released a draft federal waiver touted as an opportunity
Covered Outpatient Drugs Federal Final Rule. Medical Assistance (MA) Program Fee-for-Service (FFS) Pharmacy Reimbursement
Covered Outpatient Drugs Federal Final Rule Medical Assistance (MA) Program Fee-for-Service (FFS) Pharmacy Reimbursement 1 Background On February 1, 2016, the Centers for Medicare and Medicaid Services
The Case For Value ACA to MACRA to MIPS
The Case For Value ACA to MACRA to MIPS 2016-2019 Robert E Nesse M.D. Professor of Family Medicine Mayo Medical School Senior Director of Health Care Policy and Payment Reform nesse.robert@mayo.edu What
Medicare Releases Final Rule for the Second Year of the Quality Payment Program
Medicare Releases Final Rule for the Second Year of the Quality Payment Program On Nov. 2, 2017, CMS issued the Calendar Year 2018 Quality Payment Program (QPP) final rule for the second transition year
The Tech-Enabled Provider Organization: The 2017 OPEN MINDS Health & Human Services Technology Survey
The Tech-Enabled Provider Organization: The 2017 OPEN MINDS Health & Human Services Technology Survey November 2017 1 www.openminds.com 15 Lincoln Street, Gettysburg, Pennsylvania 17325 Phone: 717-334-1329
Value-Based Payment Reform Academy: What to Consider when Designing a Risk Adjustment Strategy for Value-based APMs for FQHCs
Value-Based Payment Reform Academy: What to Consider when Designing a Risk Adjustment Strategy for Value-based APMs for FQHCs FOR AUDIO, PLEASE DIAL: ( 866) 7 40-1260 A CCESS CODE: 2 383339 M A Y 1, 2017
ACOs: Parental Discretion Advised
ACOs: Parental Discretion Advised NJ PHL HFMA 2011 Annual Institute October 12, 2011 Today s Agenda What s in it for me? 2 Bill Phillips 786 371 6493 1 A. Shared Savings Programs 3 Shared Savings Programs
The New York State Value-Based Payment (VBP) Roadmap. Community Based Organizations February 28, 2018
The New York State Value-Based Payment (VBP) Roadmap Community Based Organizations February 28, 2018 1 Housekeeping All lines have been muted To ask a question at any time, use the Chat feature in WebEx
Thank you, and enjoy the webinar.
Disclaimer This webinar may be recorded. This webinar presents a sampling of best practices and overviews, generalities, and some laws. This should not be used as legal advice. Itentive recognizes that
MACRA Final Rule Summary
MACRA Final Rule Summary On October 14, 2016, the Centers for Medicare and Medicaid Services (CMS) released its final rule implementing the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA),
Medicaid FQHC APMs What are they and what do they mean for health centers? Alex Harris, MSPH Deputy Director, Transformation Policy
Medicaid FQHC APMs What are they and what do they mean for health centers? Alex Harris, MSPH Deputy Director, Transformation Policy aharris@nachc.org What does payment reform look like for health centers?
RFS-6-68 HOOSIER HEALTHWISE STATE/MCO CONTRACT ATTACHMENT D: MCO SCOPE OF WORK. Table of Contents
Table of Contents 1.0 Managed Care Organization s (MCO s) Administrative Requirements... 5 1.1 Managed Care Organizations... 5 1.2 Administrative Structure of Managed Care Organizations... 5 1.3 Staffing...
FAMILY CARE HOME AND COMMUNITY-BASED SETTINGS TRANSITION PLAN
FAMILY CARE HOME AND COMMUNITY-BASED SETTINGS TRANSITION PLAN Submitted to CMS: October 2, 2014 Purpose The Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS) published
The Road to Value. Aric R. Sharp, MHA, CMPE, FACHE Vice President Accountable Care UnityPoint Health February 3, 2017
The Road to Value Aric R. Sharp, MHA, CMPE, FACHE Vice President Accountable Care UnityPoint Health February 3, 2017 1,500 Physicians UnityPoint Clinic 17 hospitals + 15 rural network hospitals 35,000
CY 2018 Quality Payment Program Final Rule Summary
CY 2018 Quality Payment Program Final Rule Summary On November 2, 2017, the Centers for Medicare and Medicaid Services (CMS) released its final rule outlining the requirements for year two of the Quality
2014 Physician Quality Reporting System: Group Reporting Requirements
2014 Physician Quality Reporting System: Group Reporting Requirements Lisa Lentz, MPH, Health Insurance Specialist and LeTonya Smith, CRNP, Health Insurance Specialist Presentation to the American Medical
Compensation and Reimbursement
492 Pharmacy Management: Compensation and Reimbursement Positions Compensation and Reimbursement Revenue Cycle Compliance and Management (1710) To encourage pharmacists to serve as leaders in the development
Value-Based Purchasing for Managed Long- Term Services and Supports (MLTSS)
Value-Based Purchasing for Managed Long- Term Services and Supports (MLTSS) Erin October 24, 2017 Contents MLTSS Program Growth Value-Based Purchasing and Payment Reform Value-Based Care in MLTSS Programs
than value. infrastructure for value-based payment, it is apparent that greater assumption of
EXECUTIVE BRIEFING Value-Based Contracting: How to Think Like a Payer It is widely recognized that the rate of healthcare spending in the U.S. is unsustainable. In recent years, experts of all types, from
The Pharmacists Society of the State of New York
The Pharmacists Society of the State of New York Gregory S. Allen January 29-31, 2017 2 Agenda The DSRIP Challenge: Transforming The Delivery System Moving Towards Improved Quality Through Value Based
10/10/2012. Goals. The Exciting Future of Practice Management. Practice Management. Practice Management. The Future. Practice Management
Goals The Exciting Future of Practice Management Define practice management Current expectations of practice managers How practice management is changing Finding success as a practice manager Looking to
Meaningful Use Requirement for HIPAA Security Risk Assessment
Meaningful Use Requirement for HIPAA Security Risk Assessment The MU attestation requirement does not state that any gaps must be resolved prior to meaningful use attestation. Mary Sirois, MBA, PT, CPHIMSS
National Association of ACOs. ACO Cost and MACRA Implementation Survey. May
National Association of ACOs ACO Cost and MACRA Implementation Survey May 2016 www.naacos.com ACO Cost and MACRA Implementation Survey 1 May 2016 Dear ACO Colleague: We are pleased to release the results