2013 Medicaid Fee Schedule and Eligibility changes

Find Medicaid Fee Schedule and Eligibility changes update for 2013.

Medicaid Changes are aimed at strengthening the American health care system by increasing the income physicians take home and expanding Medicaid through Preventive care. This will focus in bolstering children Health insurance program while also launching streamlined Medicare billing.

Thus, it is all in blue print that the health care system in the US is bound to experience lots of drastic changes in terms of payments. In the following we are going to present a summery of 2013 Medicaid Fee Schedule and Eligibility changes:

2013 Medicaid Fee Schedule and Eligibility changes

Payment to hospitals under the new plan is to be given a boost of 4.6billion up to 48.1 billion in a year. Under the new plan, payments are guaranteed to reduce by up to 2% for any hospitals that do not meet the outpatient quality reporting requirements. OPPS future payments will be based on geometric mean costs rather than the average median costs. This is mainly geared at ensuring that patients are accorded the highest quality of health services at minimal costs. Changes expected in Medicaid include:

1. OPPS Payment Adjustments

   A continuation of 7.1% adjustment on OPPS payment is expected to certain rural hospitals and sole community hospitals. This is only applicable for services paid under OPPS excluding any drugs and biological devices paid under Pass through payment Policy.
   
   

2. Marginal Cost Payment Adjustments

   There will also be an adjustment on any payments that cover any marginal cost of hospitals. Payment adjustment will also be experienced on the use of non enriched Uranium sources of Radio isotopes mainly used in medical imaging.
   
   

3. Coverage for separately Payable Drugs and Devices in New Plan

   Under the new plan, there will be payment that covers all the acquisition of separately payable drugs and biological devices that do not have the statutory pass through status.
   
   

4. Inpatient Rehabilitation Facility Quality Reporting Program

   There was also an adoption of measures for inpatient rehabilitation facility quality reporting Program. The new plan will affect payments for 2014 as the adoption of new pressure ulcer measures. Face to face encounter will also be required for payment for any durable medical equipment. This applies for things like prosthetic devices orthotics and prosthetics.
   
   

5. New Medicaid Rates for 2013 and 2014

   The new changes require Medicaid agencies to pay the new Medicare rates in effect from 2013 and 2014. This payment requirement applies to all primary care services paid on a free for service basis. The federal government is mandated to cater for any incrementing payments. The new changes are also aimed at physicians due to their role in providing direct service to patients.
   
   

6. More Coverage in Medicare new Plan

   The new plan comes with its pros. People with poorly performing plans will be notified in advance of better plans so that they can switch. Medicare in 2013 will also cover things such as screenings for depression obesity and sexually transmitted diseases. The new changes are also meant to ensure that new plans are able to cover for behavioural therapy and cardiovascular diseases. Value based payment that mostly affects physicians is another aspect that will come into effect. This deals with the adjustment of payments made to a physician group under the new Medicare physician fee schedule.
   
   

7. Incentives for Physicians with more experience and low costs

   The CMS planned to apply the new plan under medical groups of 25 or more but changed the plan to include 100 or more physicians. Under this new modifier, physicians with more experience and higher quality services at low costs will be paid more. Physicians under this plan will have the role of determining how the modifier gets calculated. This will be done through PQRS (Physicians Quality Reporting System) which is a voluntary program that allows physicians to report on the quality of service that they offer to patients.
   
   

8. Non Random Prepayment Review Regulations

   Another evident change is the removal of regulations that regard the termination of non random prepayment review. Medical review refers to the procedures carried out by medical contractors so as to ensure that billed items or services are covered and are even-handed. Medical contractors will terminate the non random prepayment medical review when all medical billing requirements are met.