Medicare & Medicaid

Medicaid Set to Mail “Sample” Reports

Initial Set of Episodes:  Acute Upper Respiratory Infections, ADHD, and Pregnancy Episodes Within the next couple of days, physicians and other providers who have been identified as principal accountable providers (PAP) for the first set of episodes will begin receiving reports on their cost of care for 2011. …

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Medicaid Implements “Preventable Condition” Rule

Effective July 1, 2012, Arkansas Medicaid will be implementing 42 CFR 477.26 (c)(1); which requires that all state Medicaid plans prohibit payment for "provider-preventable conditions." The umbrella term "provider-preventable conditions" (PPCs) includes two separate categories: "healthcare-acquired conditions" (HCACs) and "other provider-preventable condition" (OPPC). HCACs apply to Medicaid inpatient…

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Medicaid Releases Episode Thresholds

The Arkansas Medicaid program has released the cost threshold targets for its initial set of treatment episodes under the episode of care payment model. Those thresholds are: Non-specific Acute Ambulatory Upper Respiratory Infection $46-67 Acute Pharyngitis $60 - $80 Acute Sinusitis $68 - $87 Perinatal Care $3394 -…

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