by purush167 | Dec 10, 2022 | Medicare payment basics
MANAGEMENT INFORMATION SYSTEM (MIS) A. The MCO shall operate the MIS capable of maintaining, providing, documenting, and retaining information sufficient to substantiate and report MCO’s compliance with the n contract requirements. The MCOs must maintain current...
by purush167 | Nov 21, 2022 | Medicare payment basics
TRANSITIONING/TRANSFERRING OF ENROLLEES A. Transitioning Recipients into MCOs The MCO will be responsible for enrollees as soon as they are enrolled and the MCO is aware of the enrollee in treatment. The MCO must have policies and procedures for transitioning...
by purush167 | Oct 8, 2022 | Medicare payment basics
Overview of the Patient-Driven Groupings Model The Patient-Driven Groupings Model (PDGM) uses 30-day periods as a basis for payment. Figure 1 below provides an overview of how 30-day periods are categorized into 432 case-mix groups for the purposes of adjusting...
by purush167 | Sep 13, 2022 | Medicare payment basics
Introduction – WCMSA If you have decided to self-administer your CMS-approved Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA), this Toolkit can help you manage your account appropriately and satisfy Medicare’s interests related to future medical...
by purush167 | Aug 24, 2022 | Medicare payment basics
Overview of Medicare Cost Reports Institutional providers certified by the Medicare program are required to submit cost reports to Medicare Administrative Contractors (MACs) annually (Centers for Medicare and Medicaid Services [CMS], 2016). CMS makes cost report data...
