AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |
Back to Blog
Abcds of medicare yihaes makonnen4/15/2024 It is important to note that these NTAP payments do not currently exist for SNFs, as such NTAP meds started in hospitals have a difficult time continuing in SNFs. The financial considerations are based on reductions in expenditures, such as length of stay, ICU days, ventilator days and readmission rates.Īlso taken into consideration is the patient’s ability to have additional coverage from payers through carve-outs from the capitated payment, especially now in the form of New Technology Add-on Payment (NTAP) reimbursements. From here, the decision typically moves to the hospital’s lead pharmacist, who can provide a more in-depth clinical outcome assessment against existing treatment options and financial considerations. The principal decision-makers for hospitals start with clinical key opinion leaders (KOL), who base their selection on clinical outcomes, such as efficacy and adverse event (AE) reduction. As a result, drug usage is controlled by these facility operators rather than traditional insurers. Drugs used during an inpatient stay in a hospital or skilled nursing facility (SNF) (subacute stay) or during hospice enrollment are paid for by the facility or program from the capitated funds received from payers. The ABDCs of Medicare drug coverage begin with Medicare Part A, which provides drug benefits during an inpatient stay. This article describes each part of Medicare with key coverage details and outlines how pharmaceutical manufacturers need to navigate each part of the ABDCs of Medicare to assure access and utilization for Medicare beneficiaries. ![]() Of course, many coverage details are in a constant state of flux, affecting exactly how coverage is provided. Together, the four parts provide medication coverage – from oral medications taken at home to IV treatments given in a physician’s office to all medication provided during a hospital stay. ![]() We invite all comments in regard to this article.The Medicare benefit is divided into four parts, each providing a unique drug benefit. We hope they have been enlightened and we have provided clarity as to the differentiation of each of Medicare’s parts. This article completes the series on Deciphering the ABCDs of Medicare. It is illegal for anyone to sell you a Medicare supplement if you have a Medicare Medical Savings Account plan.Medicare supplements do not cover prescription drugs.Medicare supplements require guaranteed renewal.You can buy Medicare supplements from any insurance company licensed in your state.Medicare supplements apply to only one person – doesn’t extent to a spouse.Premiums are charged for Medicare Supplements in addition to the premiums paid for Plan B.You can apply for a Medicare supplement even if you have a Medicare Advantage plan.You must have both Medicare A and B since this type of insurance is a “supplement”.Here is a good article on how does Medicare Advantage, Medicare Supplemental Insurance differ. This type of insurance is used to fill in the gaps and provide coverage for some of the things Medicare doesn’t cover such as: coinsurance, co-payments, and deductibles.įor more information on Medicare Supplemental Insurance, visit AARP. The missing link is called Medigap insurance or maybe referred to as a Medicare supplement. ![]() ![]() In lieu of an official Part E of Medicare, there is an additional aspect of Medicare deserving consideration. Nothing ever become of the proposal, but with the current political climate revisiting “Medicare for All” you may want to read this Brookings report on the subject. You might be aware of now decade old proposal for a Medicare Part E(veryone). This article is part of a series of articles: Medicare is defined according to (the official site for Medicare) as “the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Failure (permanent kidney failure requiring dialysis or a transplant, sometimes called ERSD)”. Are you in the know about the ABCDs of Medicare: Part E?
0 Comments
Read More
Leave a Reply. |