DOES DOING YOUR HOMEWORK
PAY OFF?
start a patient to see if you can even
complete the services.
Accountable Care Organizations
are the next new thing to make our
lives more difficult. Essentially, it is a
network within a network. Practices
that are using the ACO model will
require you to be part of their internal
network.
Another new concept is the Dual
Eligibles program. This is supposedly
a seamless Medicare/Medicaid
program that “simplifies” billing
to a Medicaid contractor that
processes the claims and produces
one reimbursement check for both
programs. This currently is in place
in three states, my own of Ohio being
one of them. Advertised as cost saving
program where both government
entities get together to provide a
cohesive care plan for dual eligible
beneficiary, in Ohio, it turned out to
be a nightmare for providers.
Two days before New Year’s the state
Medicaid department send out an
email entitled “general information
for Medicaid providers” that turned
out to be nothing of the sort. Most
providers don’t read these “general
information” messages as they usually
are just this side of spam. This one
was not. It informed everyone that
effective January 1 that Ohio would
no longer be covering deductibles
and copays for certain professions,
ours included. Then we come to
find out that the “reimbursed at
Medicare allowable” meant sixty-five
" Accountable Care Organizations are the next
new thing to make our lives more difficult. "
Current Pedorthics March/April 2016
41