We think you have liked this presentation. If you wish to download it, please recommend it to your friends in any social system. Share buttons are a little bit lower. Thank you!
Presentation is loading. Please wait.
Published byProsper Reynolds
Modified about 1 year ago
Idaho Industrial Commission Public Hearing October 15, 2007
© Ingenix, Inc. 2 Using Information to Form Conclusions: Idaho Professional Services Information from SIF Medicare Ingenix Data Health Plan Data Surrounding States External Resources 102% Above Transitional Medicare Greater than 80 th Percentile 3 rd highest of 7 neighboring states Resources indicate high reimbursement Remaining ‘As Is’ to Revised Methods Likely Stakeholder Meetings; TBD
© Ingenix, Inc. 3 Key Findings Using the 2006 data studied with the current conversion factors, the IIC is approximately 102% above Idaho Medicare. The 36 individual conversion factors have considerable variances in amounts on a type of service basis when using Medicare as a benchmark. The IIC schedule was analyzed using the Ingenix MDR 50 th and 80 th allowed percentiles. IIC reimbursement was greater than the 80 th percentile. For select codes, (top 20 work comp codes), IIC is 3 rd highest among its neighboring 7 states. Idaho has the lowest number of physicians per 100,000 population. Incentives may be required so that physicians treat workers’ compensation patients. The needs of the injured employee are most important - Access to care must not be hindered.
© Ingenix, Inc. 4 The IIC Proposal Idaho Industrial Commission is proposing ten conversion factors. Modeling the IIC proposal using the Top 500 criteria shows: Near budget neutral results Increases to: –Medicine Codes –Surgery Group 3 –Surgery Group 5 Decreases to: –Surgery Group 1 –Surgery Group 2 –Surgery Group 4 Radiology and Path / Lab remain the same Note on case mix / reduction of conversion factors Minimal changes in type of service category impact using Top 500 criteria. Percentages above national Medicare range from 269% for Surgery Group I to 19% above national Medicare for Medicine Group I
© Ingenix, Inc. 5 Conversion Factor Comparison: Proposed vs. Other National and State Benchmarks
© Ingenix, Inc. 6 Credits / Acknowledgements CPT only copyright 2003 - 2006 American Medical Association. All Rights Reserved. CPT codes, descriptions, and other CPT material only are copyright 2003 - 2006 American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained or not contained herein. Some information from CMS.gov State of Montana: http://erd.dli.mt.gov/wcregs/wcrdocs/MNFSInstructionV1.pdfhttp://erd.dli.mt.gov/wcregs/wcrdocs/MNFSInstructionV1.pdf State of Utah: http://www.laborcommission.utah.gov/indacc/WC_Forms___Publications/Med%20Fe e%20Guidelines%20%202007%208-07.pdf http://www.laborcommission.utah.gov/indacc/WC_Forms___Publications/Med%20Fe e%20Guidelines%20%202007%208-07.pdf State of Oregon: http://wcd.oregon.gov/policy/rules/docconv_12578/9_07051ub.pdfhttp://wcd.oregon.gov/policy/rules/docconv_12578/9_07051ub.pdf State of Washington: http://www.lni.wa.gov/ClaimsIns/Providers/Billing/FeeSched/2007/policy2007.asp#hig hlights http://www.lni.wa.gov/ClaimsIns/Providers/Billing/FeeSched/2007/policy2007.asp#hig hlights
RVU Relative Value Unit Report Copyright © 2012 Waiting Room Solutions.
Identifying Medical Cost Drivers in Workers’ Compensation: Tools Available for Public Officials.
Workers Compensation Medical Fee Schedule Overview Paul Smallcomb Client Service Manager Medical Group Business Services.
CDM Coding & Compliance Module Web-based CDM Maintenance System.
Copyright © 2008 Delmar Learning. All rights reserved. Chapter 9 CMS Reimbursement Methodologies.
Copyright ©2012 Delmar, Cengage Learning. All rights reserved. Chapter 15 Procedural and Diagnostic Coding.
1 MEDICARE ADVANTAGE PLANS: MEDICARE COSTS IN 2007 Brian Biles, MD, MPH Department of Health Policy George Washington University June 3, 2007.
Workers’ Compensation Claim and Professional Medical Service Denials: An Examination of Trends Texas Department of Insurance Workers’ Compensation.
Funds Flow for Johns Hopkins Department of Surgery October 4, 2015 Joint SSC and AASA Session Presented by: John D. Hundt.
SGR Formula Effect Prepared by: Lisa Patrick, MD Mount Sinai School of Medicine.
SC Workers’ Compensation Commission SC Hospital Association Managed Care Directors October 9, 2012.
Milliman & Robertson, Inc. INTERNATIONALLY Woodrow Milliman 1 Casualty Actuarial Society 1999 Special Interest Seminar Health and Managed Care October.
Chris Mancill Director, Global Government Affairs Amgen Inc. The Role of Appropriate Coding.
1 Woonsocket Education Department Woonsocket Education Department FY14 Budget Presentation Giovanna Donoyan, PHD Superintendent of Schools May 2013.
Casualty Loss Reserve Seminar Workers Compensation Selected States Issues Florida, California & New York.
Conducting a Medical Practice Assessment. PurposePurpose To determine the readiness of the medical practice to receive payment by a given reimbursement.
Copyright McGraw-Hill/Irwin, 2002 The Health Care Industry Quality of Care Limited Access Increasing Demand for Health Care Role of Health Insurance.
EHR Incentive Program & Meaningful Use in Washington State An Overview.
The New NCCI Hazard Groups Greg Engl, PhD, FCAS, MAAA National Council on Compensation Insurance CASE Fall Meeting September 13, 2006.
Cost Drivers of Cancer Care: Medicare and Commercially Insured Populations Pamela Pelizzari April 1, 2016.
© 2014 American Orthotic & Prosthetic Association All rights reserved.
Maine Workers’ Compensation Medical Fee Schedule Maine Workers’ Compensation Board Office of Medical/Rehabilitation Services Presentation to the Maine.
1. 2Workers' Compensation Workers’ Compensation and The Three Parts Workers’ Compensation is a social insurance program that provides: Medical care.
Pathology and Laboratory Chapter CPT® CPT® copyright 2010 American Medical Association. All rights reserved. Fee schedules, relative value units,
Tort Reform Gina Bollotta | Chester Conforte | Ari Friedman Michael Lucas | Andrew Sidoti | Chris Tornabene Jesse Worbington.
CRIME VICTIMS COMPENSATION PROGRAM Fee Schedule Implementation.
1 Managed Health Care Pricing for Provider Arrangements Presented by Vanessa Olson Seminar on Health and Managed Care October 18, 1999.
©2011 Coventry Health Care. All rights reserved. Proprietary – Do not copy, distribute or disclose without permission of Coventry Health Care. Provided.
Female Genital System. CPT® copyright 2012 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors.
Continuity Clinic Coding Patient Encounters EPISODE 1 Concepts.
Chapter 7 Study Guide CPT Coding. 1. CPT-4 is published annually by AMA CMS WHO Medicare 2. The hospital assigns CPT codes to report Inpatient ancillary.
Legislative Analyst’s Office Presented to: Ryan Woolsey, Fiscal and Policy Analyst CSDA/CWDA Policy Symposium March 4, 2015.
The French Healthcare System
Basic Introduction to ICD-10 CM/PCS. ICD-10 Implementation October 1, 2015 – Compliance date for implementation of ICD-10-CM (diagnoses) and ICD-10-PCS.
The Complete Procedure Coding Book By Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA Chapter 2 Introduction to Coding and CPT Copyright © 2009 by The McGraw-Hill.
OVERVIEW OF WORKERS’ COMPENSATION FOR WEST VIRGINIA PROVIDERS March 2012 Leah Klinke West Virginia United Insurance Services Health Partners Network.
Comprehensive Health Insurance: Billing, Coding, and Reimbursement Deborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes.
EXPERTISEPARTNERSHIP VALUE January 26, ND QUARTER UTILIZATION REVIEW – 7/1/2010 TO 12/31/10 TRENDSANALYSISSTATISTICSPLANNINGTOOLS.
Balance Billing Ashley Norse MD Immediate Past President Florida College of Emergency Physicians October 15, 2015 Daniel F. Brennan MD Chair, Medical Economics.
Reimbursement Policy Professional Fee time based billing RVU and reimbursement are 100% equal to face to face service Colorado Medicare – Reimburses if.
Lani Berman October 21, 2008 Gainsharing and Incentives: Legal and Operational Issues Hospital-Physician Partnership to Reduce Waste and Maintain/Improve.
Azara Proprietary & Confidential Overview June 2014 Improving Patient Outcomes through Data.
Health Care Chapter 21 McGraw-Hill/Irwin Copyright © 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
Copyright 2011 J.R. Henry Consulting Inc. Presented by: Best Practices Discussion Hosted by:
Hospital Closings and Patient Visits Prepared by: Brian T. Kloss, DO, JD, PA-C SUNY Upstate Medical University Department of Emergency Medicine.
APA 2005 The New Psychological and Neuropsychological Testing Codes Antonio E. Puente American Psychological Association August, 20, 2005 Washington, D.C.
Provided by Coventry Health Care ©2011 Coventry Health Care. All rights reserved. Proprietary – Do not copy, distribute or disclose without permission.
Azara Proprietary & Confidential Cervical Cancer Screening 2014 Measure Changes Improving Patient Outcomes through Data.
PENSION REFORM: LACERS TIER II P RESENTATION TO L ABOR O RGANIZATIONS Office of the City Administrative Officer City of Los Angeles September 6, 2012.
© 2017 SlidePlayer.com Inc. All rights reserved.