Northwest December Newsletter
December 14, 2017Help Your Patients Save Money on Meds When prescribing medications to our Medicare Advantage members, remember that they have no copay or deductible for Tier 1 preferred generics.
Help Your Patients Save Money on Meds When prescribing medications to our Medicare Advantage members, remember that they have no copay or deductible for Tier 1 preferred generics.
Certain self-funded group plans require preauthorization on CPAPs and supplies. These groups include:
2017 Provider and Risk Adjustment Workshop We're partnering with Carle to present a provider workshop on Thursday, October 26 at the Carle Forum. Doors open at 5:30 p.m., and the workshop starts at 6 p.m.
CMS Education on Medicare Skilled Nursing and Therapy Services Coverage The Centers for Medicare and Medicaid (CMS) want to remind you that the Jimmo v. Sebelius Settlement Agreement clarified that Medicare covers skilled nursing care and skilled therapy services under its skilled nursing facility, home health, and outpatient therapy benefits when a patient needs skilled care in order to maintain function or to prevent or slow decline or deterioration (provided all other coverage criteria are met). This may reflect a change in practice for those of you who thought that Medicare only covers nursing and therapy services under these benefits when a patient is expected to improve.
CMS Education on Medicare Skilled Nursing and Therapy Services Coverage The Centers for Medicare and Medicaid (CMS) want to remind you that the Jimmo v. Sebelius Settlement Agreement clarified that Medicare covers skilled nursing care and skilled therapy services under its skilled nursing facility, home health, and outpatient therapy benefits when a patient needs skilled care in order to maintain function or to prevent or slow decline or deterioration (provided all other coverage criteria are met). This may reflect a change in practice for those of you who thought that Medicare only covers nursing and therapy services under these benefits when a patient is expected to improve.