by purush167 | Mar 28, 2023 | Medicare payment basics
HOME HEALTH AGENCY (HHA) SERVICES: The Division of Health Care Financing and Policy (DHCFP) Home Health Agency (HHA) Program is a mandated home health care benefit provided to recipients in his/her residence. HHA services are a component in the continuum of care which...
by purush167 | Feb 9, 2023 | Medicare payment basics
How to Identify Members When members arrive at your office, remember to ask to see their current member identification (ID) cards at each visit. This will help you identify the product the member has and get dental plan contact information. It will also help you with...
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...
