CMS Wants to Know - Can Medicaid Beneficiaries Find a Doctor?

The Centers for Medicare and Medicaid Services (CMS) is planning to conduct its first nationwide research effort to answer the question of whether adult Medicaid beneficiaries can find providers, and if factors such as being in managed Medicaid versus a fee-for-service offering aid or hurt the search. 

What it's likely to find, according to interviews conducted with state Medicaid officials and medical society officials in 20 states, is a mixed picture overshadowed by general concerns that reimbursement rates remain too low to entice many doctors to accept new Medicaid patients. Read the article in Modern Healthcare here.

CMS Proposes Rule to Expand Telehealth Payments

Wellness and behavioral health visits are among a few telehealth coverage expansions the Centers for Medicare & Medicaid Services (CMS) wants to add to the list of Medicare reimbursable telehealth activities under a proposal released Thursday last week. Providers also would be paid for telehealth services in rural areas nearer big cities under a geographical expansion in the proposed rule.

The 609-page proposed rule principally deals with annual changes to polices under the Medicare Physician Fee Schedule, including eliminating the exclusion for continuing medication education (CME) under the Sunshine Act that requires drug companies and medical device makers to disclose payments to physicians.
Added to the list of covered telehealth services by the proposal are annual wellness visits, both for an initial visit, and for subsequent visits, if they include a personalized prevention plan of service. 

Read the article in Modern Healthcare here (requires a free subscription).

A June 27th article in Insurancenewsnet.com discusses four major barriers to telehealth adoption. Read the article here, which includes an interview with Ed Bostick, Executive Director of the Colorado Telehealth Network.

With ICD-10 Delayed, Answers Needed from CMS

As part of the House's Protecting Access to Medicare Act of 2014, which delays cuts in physician's Medicare rates (SGR) by another year, the national implementation of the next-generation medical coding system known as ICD-10 has also been pushed out. This delay has focused intense attention on the Centers for Medicare and Medicaid Services (CMS) to provide clarity for how hospitals, doctors, insurance companies should move forward.

The bill signed by President Obama on Tuesday prohibits CMS from enforcing any mandate to switch to the newer system until at least Oct. 1, 2015, but the act leaves CMS with many questions to answer. Among them:

• Will Oct. 1, 2015, become the new deadline?
• Will the agency allow organizations that are ready to implement ICD-10 to do so voluntarily?
• Would the agency scrap ICD-10 altogether and instead wait for ICD-11, which is due to be released in 2017?

Read the article in Modern Healthcare here.