Archive for August 2012
Come fall, the Pennsylvania Department of Welfare (DPW) will introduce a new system that performs an automated review of Medical Assistance claims before the state pays those claims. The new system employs a computer program called InvestiClaim that will review claims for procedure or diagnosis codes with inadequate medical documentation, duplicate claims, provider types, license numbers, and other considerations. The state projects that this new system will save $5 million a year. The future use of a system to review claims prior to payment was included in Governor Corbett’s original Medical Assistance budget proposal for FY 2013. Read more about InvestiClaim and how it will work in this PA Independent article.
Medicaid improves access to care and saves lives and deserves to be expanded in the manner envisioned in the Affordable Care Act, according to a new blog entry on the web site of the health care-focused Commonwealth Fund. According to the blog commentary, Medicaid “fulfills the two main purposes of health insurance – ensuring access to needed care and providing adequate financial protection from burdensome medical expenses.” It also cites research that “confirms that expanding Medicaid not only improves access to care and financial protection of vulnerable individuals and families, but actually saves lives.” In addition, the blog suggests that Medicaid recipients have only slightly greater cost-related access-to-care problems than individuals with private insurance. The Safety-Net Association of Pennsylvania (SNAP) … Read More
The Department of Public Welfare (DPW) has issued a number of new bulletins governing Pennsylvania’s Medical Assistance program. These new regulations include an amendment to the state’s Medicaid plan for children with disabilities; the process for prior authorization of pituitary suppressive drugs; the process for prior authorization of erythropoiesis stimulating protein; the process for prior authorization of benign prostatic hyperplasia treatments; the process for prior authorization of antibiotics (GI); and the process for the prior authorization of platelet aggregation inhibitors. In addition, DPW formally announced the expansion of HealthChoices to 13 counties in western Pennsylvania and the termination of ACCESS Plus in those counties effective October 1 and its intention to publish in the near future a new bulletin adding … Read More
A new Medicare reimbursement policy that will penalize hospitals financially for readmitting patients within 30 days of discharge will have a disproportionate impact on hospitals that care for large numbers of low-income patients. According to an analysis by Kaiser Health News, hospitals that treat significant numbers of low-income patients – those eligible for Medicare disproportionate share (DSH) payments – are more likely to be penalized by Medicare than other hospitals. Those that serve the most poor patients are twice as likely to suffer the maximum Medicare penalty as those that care for the fewest low-income patients. The penalties apply to patients readmitted after suffering pneumonia, heart attacks, and heart failure. The new Medicare readmissions reduction program poses a particular challenge … Read More
The Pennsylvania Department of Public Welfare (DPW) has released its annual list of inpatient hospitals that qualify for Medical Assistance disproportionate share (DSH) payments, including the DSH percentages for acute-care general hospitals, psychiatric units of inpatient hospitals, drug and alcohol units of inpatient hospitals, medical rehab units of inpatient hospitals, freestanding rehab hospitals, private psychiatric hospitals, and private drug and alcohol hospitals. Find the list and the corresponding DSH percentages in this Pennsylvania Bulletin notice.
A study published in the journal Health Affairs found that 32 percent of office-based physicians in Pennsylvania do not accept new Medicaid patients. This is slightly higher than the nation-wide rate of 30.9 percent of physicians who will not accept new Medicaid patients. Read more about the study in this Central Penn Business Journal article or find the study itself here, on the Health Affairs web site.
In an extensive interview with the Central Penn Business Journal, Pennsylvania Department of Public Welfare Secretary Gary Alexander shared his views on the state’s Medicaid program, the changes he would like to see, and the challenges the state faces in the immediate future. Among the issues Alexander addressed are his desire to have greater flexibility to operate the state’s Medical Assistance program; the state’s prospects for expanding Medicaid eligibility as called for in the Affordable Care Act; his concern that greater access will increase rather than decrease uncompensated care and emergency room use; his interest in greater transparency for health care costs and quality; and his fight against fraud, waste, and abuse. Read the complete Central Penn Business Journal interview … Read More
The Pennsylvania Department of Public Welfare (DPW) has issued a new Medical Assistance Bulletin updating its procedures for seeking prior authorization for opiate dependence treatment. The new bulletin, which can be found here, applies to all licensed pharmacies and prescribers enrolled in the state’s Medical Assistance program that provide services through the Medical Assistance fee-for-service program. An update of the Medical Assistance handbook for prior authorization of these services can be found here. The new policy takes effect on September 10.
The Pennsylvania Department of Public Welfare has issued a new Medical Assistance Bulletin updating the state’s preferred drug list. This bulletin applies to all licensed pharmacies and prescribers enrolled in the state’s Medical Assistance program that provide services in the fee-for-service delivery system. The new bulletin can be found here. Another document, an update of the Medical Assistance prior authorization handbook for pharmaceutical services, can be found here. The new policies take effect August 13.
The Payment Data Advisory Group of the Pennsylvania Health Care Cost Containment Council (PHC4) will meet on Wednesday, August 8 in Harrisburg. The meeting will be held at the PHC4 office at 225 Market Street, Suite 400. It begins at 10:30 a.m. The public is welcome to attend.