Medicare and Medicaid Fee for service Payments

This book discusses the fee-for-service (FFS) provisions of the legislation, those affecting Medicaid as well as the Medicare cost containment provisions.

Medicare and Medicaid Fee for service Payments

Author: Percy W. Bryan

Publisher: Nova Publishers

ISBN: 9781594540660

Page: 146

View: 266

On 22 November 2003, the House of Representatives voted 220 to 215 to approve the conference report on H.R. 1, the Medicare Prescription Drug, Improvement, and Modernisation Act of 2003. The Senate, on November 24th, voted 54 to 44 to approve the conference report. The bill was signed by the President in a ceremony on December 8th. The legislation adds a prescription drug benefit to Medicare and replaces the existing Medicare+Choice program with a new Medicare Advantage program that establishes managed care payments based on a system of bids and benchmarks. The bill also contains numerous provisions that would generally increase fee-for-service payments within Medicare's Part A and Part B program (also known as traditional Medicare), especially for rural health care providers; numerous regulatory and administrative practices will also be modified. This book discusses the fee-for-service (FFS) provisions of the legislation, those affecting Medicaid as well as the Medicare cost containment provisions. It compares the provisions in the bill as enacted with those in the Medicare reform bills that were originally passed by the Senate and the House. through VIII; some FFS provisions are included in Titles VIII through X as noted. The cost containment provisions are in Title VIII and the Medicaid and other provisions are in Title X. CONTENTS: Preface; Introduction; Changes to Medicare's Fee for Service Program; Index.

Medicaid Payment

"Medicaid provided health coverage forover 70 million individuals in fiscal year2013 through a combination of FFSand managed care at a cost of about$460 billion.

Medicaid Payment

Author: U.s. Government Accountability Office

Publisher:

ISBN: 9781973958413

Page: 32

View: 604

"Medicaid provided health coverage forover 70 million individuals in fiscal year2013 through a combination of FFSand managed care at a cost of about$460 billion. Yet, limited information isavailable on how provider paymentsper service under Medicaid FFS andmanaged care compare with privateinsurance and with one another. Thisreport builds on a prior GAO study onMedicaid payments by comparingpayments for E/M services underMedicaid FFS, managed care, andprivate insurance prior to 2013, whentemporary Medicaid paymentincreases for these services tookeffect, as mandated by HCERA.In this report, GAO examines: (1) howpayments for E/M services underMedicaid FFS and Medicaid managedcare compared with private healthinsurance prior to the HCERAmandatedincreases; and (2) howpayments for E/M services underMedicaid managed care comparedwith Medicaid FFS prior to the HCERAmandatedincreases.To compare these payments, GAOanalyzed claims data from MedicaidFFS, managed care organizations, andprivate insurers. GAO comparedpayments to physicians for 26 E/Mservices in selected states, chosen onthe basis of data availability. GAOcompared Medicaid FFS paymentswith private insurance in 40 states;Medicaid managed care with privateinsurance in 23 states; and Medicaid"

Medicaid

Other cost and payment data for the 22 hospitals were from sources not subject to
audit. For the remaining 125 hospitals in California, the state used an audited
data source for Medicaid fee-for-service payment data, but cost and other
payment ...

Medicaid

Author: Katherine M. Iritani

Publisher: DIANE Publishing

ISBN: 143792736X

Page: 53

View: 976

In addition to standard Medicaid payments, hospitals receive supplemental payments for uncompensated costs of care provided to uninsured and Medicaid patients. These supplemental payments are referred to as disproportionate share hospital (DSH) payments. In FY 2006, DSH payments totaled about $17 billion and non-DSH supplemental payments exceeded $6 billion. Hospitals' DSH payments are limited to their uncompensated care costs, that is, their costs for covered care less Medicaid and other payments. This report examined: (1) how state DSH payments in 2006 compared to DSH payment limits; and (2) certain aspects of states' calculations of 2006 DSH payment limits. Charts and tables.

Evaluating Pediatric Dental Care Under Medicaid

... service cost changes that qualify under D ( 3 ) of this regulation and result from
: ( a ) An addition or deletion of services covered under the HealthChoice benefits
package ; ( b ) An increase or decrease in Medicaid fee - for - service payment ...

Evaluating Pediatric Dental Care Under Medicaid

Author: United States. Congress. House. Committee on Oversight and Government Reform. Subcommittee on Domestic Policy

Publisher:

ISBN:

Page: 231

View: 509

Departments of Labor Health and Human Services Education and Related Agencies Appropriations for 1996

The Commission indicated that Medicaid fees are about 73 percent of Medicare
levels , and are 47 percent of the rate paid ... Dr . Eisenberg : The Commission ' s
previous estimates of Medicaid fee levels focused on fee - for - service payments
 ...

Departments of Labor  Health and Human Services  Education  and Related Agencies Appropriations for 1996

Author: United States. Congress. House. Committee on Appropriations. Subcommittee on the Departments of Labor, Health and Human Services, Education, and Related Agencies

Publisher:

ISBN:

Page:

View: 483

Medicaid

Medicaid services not directly rendered by the provider are paid on a fee - for -
service basis . ... the PCCM program , providers receive a monthly per capita
case management fee of $ 2.14 plus fee - for - service payment for delivered
services .

Medicaid

Author:

Publisher: DIANE Publishing

ISBN: 9781568065885

Page: 102

View: 886

Focuses on: states' use of managed care programs; the difficulty states face in implementing certain program components; the effect of the managed care approach on health care access, quality, & cost; & the presence of features that assure the quality of health services & providers' financial stability. Charts, tables & map.

Medicaid in Schools

Improper Payments Demand Improvements in Hcfa Oversight Carolyn Yocom,
William Hamel ... School- based services play an important role in assuring that
Medicaid-eligible adolescents and children receive needed health care.

Medicaid in Schools

Author: Carolyn Yocom

Publisher: DIANE Publishing

ISBN: 9780756702984

Page: 57

View: 218

Schools can be appropriate locations in which to identify low-income children who are eligible for Medicaid, assist them to enroll, & provide Medicaid-covered services. This report addresses: the extent to which school districts & states claim Medicaid reimbursement for school-based health services & administrative activities; the appropriateness of methods that states use to establish bundled rates for school-based health services & to assess the costs of administrative activities that their schools may claim as reimbursable; states' retention of Federal Medicaid reimbursement for services provided by schools & schools' practice of paying contingency fees to private firms; & HCFA oversight of state practices.

Case Studies in Nursing Case Management

Implementing Medicaid Managed Care in Connecticut : The Hartford Hospital
Experience Cheryl Zwingman - Bagley ... As Figure 9-1 depicts , the main
difference between the traditional fee - for - service payment system and a
capitation ...

Case Studies in Nursing Case Management

Author: Suzanne Smith Blancett

Publisher: Jones & Bartlett Learning

ISBN: 9780834207899

Page: 450

View: 133

Case Studies in Nursing Case Management provides portrayals of health care organizations around the nation that have successfully implemente d case management programs. It reports on how case management is being used in inpatient, ambulatory, operating room, intensive care, home h ealth, and subacute settings. Specific populations such as pediatric, maternity, dialysis, geriatric, psychiatric, and AIDS/HIV patients are also addressed. Case managers' roles in managed care and community-ba sed settings as well as in insurance companies are described.

Let s Fix Medicare Replace Medicaid and Repealthe affordable Care Act

Instead of the fee-for-service payment process, the insurance companies are
providing “treatment packages” for those illnesses requiring the complex
treatment programs. The reimbursements for all of the numerous services these
patients will ...

Let s Fix Medicare  Replace Medicaid  and Repealthe affordable Care Act

Author: Lindsay L. Pratt, M.D.

Publisher: Author House

ISBN: 1467882380

Page: 96

View: 214

If you are you a Medicaid patient, or if you are a patient without any health insurance, I’m aware of the difficulty you have had, and are having, obtaining your healthcare services, and I agree with you. The existing investor owned and profit driven healthcare delivery system is not a friendly delivery system for those patients unable to pay for their healthcare services. But, in its place, if you are supporting the Affordable Care Act, please reconsider your support, and consider the recommendations in this book. In this book, I’m offering everyone without the ability to pay for their healthcare services, the opportunity to obtain the same quality, comprehensive, and easily available healthcare services as the services provided patients who are purchasing their health-care services. Neither Medicaid nor the Affordable Care Act can provide those same services, and the reasons why are discussed in this book. Furthermore, in addition to the difficulty patients with Medicaid and without Medicaid are having obtaining their healthcare services, patients with health insurance, regardless of its source, need to be prepared for the probability, not the possibility, of their having difficulty obtaining their healthcare services in two years when the Affordable Care Act becomes their healthcare delivery system. The frustration with Medicaid’s inadequate services is understandable, and the confusion about the future among patients with health insurance is understandable. The problem for both is the many articles written about what is happening, and will be happening, in healthcare have not correctly identified the causes of, or offered realistic solutions for, what is happening, and will be happening, in healthcare. The problem with those article’s is their misinformation and their use of conjecture. Misinformation is offered in some of those articles to support the author’s agenda. Conjecture is used by other authors. They are too young to have witnessed what happened during the 1950s and 1960s to cause what has happened in healthcare.

Medicare and medicaid implementing state demonstrations for dual eligibles has proven challenging report to the Special Committee on Aging U S Senate

United States General Accounting Office Health, Education, and Washington,
D.C. 20548 Human Services Division B-281823 Letter August 18, 2000 The ... an
estimated 97 percent of dual eligibles receive their Medicare benefits under
Medicare's fee-for-service option. ... some states are exploring the pooling of
separate Medicaid and Medicare payments and making one managed care plan
responsible ...

Medicare and medicaid   implementing state demonstrations for dual eligibles has proven challenging   report to the Special Committee on Aging  U S  Senate

Author:

Publisher: DIANE Publishing

ISBN: 1428972110

Page:

View: 675

Expanding Health Insurance Coverage and Controlling Costs for Health Care

Fee-for-service payment rates in Medicare and Medicaid are generally set
administratively. That method poses a number of challenges, including how to
determine providers' costs—particularly for services that require substantial
training or ...

Expanding Health Insurance Coverage and Controlling Costs for Health Care

Author: Douglas W. Elmendorf

Publisher: DIANE Publishing

ISBN: 1437913865

Page: 31

View: 109

Testimony on the opportunities and challenges that the Congress faces in pursuing two major policy goals: (1) expanding health insurance coverage, so that more Americans receive appropriate health care without undue financial burden; and (2) making the health care system more efficient, so that it can continue to improve Americans¿ health but at a lower cost in both the public and private sectors. Both are complex endeavors in their own right, and interactions and trade-offs between them may arise.

Medicare and Medicaid Guide

o mine the appropriateness - service payments for sen OAS ; W - 00 - 03 - 31044
; A - 06 - 03 - 00000 the identification ... Expected Issue Date : FY 2004 managed
care contracts because of the difficul - Medicaid Fee - for - Service Payments to ...

Medicare and Medicaid Guide

Author: Commerce Clearing House

Publisher:

ISBN:

Page:

View: 762

The Health Professions

States may pay healthcare providers directly on a fee-for-service basis, or states
may pay for Medicaid services through various prepayment arrangements, such
as health maintenance organizations (HMOs). Within federally imposed upper ...

The Health Professions

Author: Stephanie Chisolm

Publisher: Jones & Bartlett Learning

ISBN: 0763735205

Page: 448

View: 153

This text covers various aspects of the health professions ranging from delivering healthcare services to the disparities and inconsistencies in health care, health literacy, and much more. Also presented in this text is an overview of careers in health professions including medicine, nursing, pharmacy, and allied health.

Hospital Reimbursement

This amount is contrasted against the payments received from the state-
administered Medicaid program. ... The first is the traditional fee-for-service or
UPL (upper payment limit) program in which hospitals are paid on a claim-by-
claim basis for ...

Hospital Reimbursement

Author: Kyle Herbert

Publisher: CRC Press

ISBN: 146656802X

Page: 272

View: 134

Due to the countless variables that affect revenue and cost, the hospital reimbursement process is by far the most complex of any industry. Requiring only a basic financial background and a working knowledge of accounting, Hospital Reimbursement: Concepts and Principles supplies a clear understanding of the concepts and principles that drive the re

Health Care Politics and Policy in America

payment program . States can pay health care providers directly on a fee - for -
service basis , or states can pay for Medicaid services through a variety of
prepayment arrangements such as health maintenance organizations ( HMOs ) .

Health Care Politics and Policy in America

Author: Kant Patel

Publisher: M.E. Sharpe

ISBN: 9780765628473

Page: 506

View: 435

Fully updated for this new edition, Health Care Politics and Policy in America combines background and context for the evolution of U.S. health care policy with analysis of recent trends and current issues. The book introduces public policy students to the complex array of health care issues, and health care professionals to the study of public policy. It provides comprehensive coverage of policy issues related to health care at the federal, state, and provider/patient levels, from Medicare and Medicaid funding and managed care to medical liability law and ongoing debates over the beginning of life and end-of-life decisions. Health Care Politics and Policy in America successfully integrates political, ethical, economic, legal, technological, and medical factors in an issue-focused survey of U.S. health care policy. It includes a chronology of health care-policy-related events and legislation from 1798 through 2005, and an appendix comparing medical malpractice tort laws state-by-state.