States face challenges in rush to Medicaid managed care

Article Abstract:

The passage of the Congressional Republican's Medicare reform bill likely will have the effect of encouraging state governments to implement managed care plans for the treatment of Medicare recipients. The Republicans Medicare reform proposal would turn the Medicare system over to the states and would fund it with capped block grants, necessitating that states push Medicare recipients into managed care to control prices. Thirty-four states already have received Congressional waivers to implement managed care pilot programs that now provide treatment for one-third of all Medicare recipients.

Analysis, Forecasts and trends, Social policy, Intergovernmental fiscal relations, Republican Party (United States), State government

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Medicare shapes up claims

Article Abstract:

Medicare is developing new electronic systems to process claims for payment from physicians and medical insurance carriers. The Health Care Financing Administration, which runs Medicare, already surpasses non-government insurers in technology and efficiency, processing 79% of claims electronically and averaging only $0.94 to process Medicare Part B claims. HCFA is planning universal identification numbers for physicians and payers and a standard electronic claims format. Electronic payment also is a possibility.

Health Care Financing Admin, Information management, Claims adjustment (Insurance)

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AMA, HCFA vow to correct Medicare coding

Article Abstract:

The American Medical Association and Health Care Financing Administration promised to review the revised coding policy for Medicare claims following physicians' confusion over the recently enacted Medicare Correct Coding Initiative. The initiative was designed to lump multiple Current Procedural Terminology codes under new, more generic codes to reduce by hundreds of millions of dollars the costs to Medicare of processing physicians' claims.

Standards, American Medical Association, Codes

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