At this juncture in the evolution of case management services, we have reached the tipping point of hospitals acknowledging that they should have some evaluation of each patient’s level-of-care needs at the front door.
When executing an interstate transfer, case managers must account for different Medicaid programs and payers, high transportation costs, and unfamiliar physicians—not to mention the challenge of finding an accepting facility.
Instead of paying for hospital and physician services separately, the ACE demonstration program bundles payments for specific cardiac and orthopedic procedures into one lump sum to encourage collaboration.
CMS has once again contracted with the TMF Health Quality Institute to release Program for Evaluating Payment Patterns Electronic Reports (PEPPER) data in 2010.
You receive a letter in the mail requesting copies of medical records for an audit. It looks much like the one you received the day before, but the return address is different. And they both look quite similar to the other request for documentation you received last week.
