Advanced Imaging Reimbursement Changes Sample Clauses

Advanced Imaging Reimbursement Changes. Effective January 1, 2017, ODM modified its reimbursement policy for radiology services that occur when more than one radiology procedure is performed by the same provider or provider group for an individual patient on the same date. Payment for the primary procedure is made at 100% of the Medicaid fee schedule amount. Each additional professional component of the procedure is reduced to 95% of the Medicaid fee schedule amount, compared to the prior policy of paying each additional professional procedure at 75% of the Medicaid fee schedule amount.  Dental Program Changes. Effective April 1, 2018, Silver Diamine Fluoride (SDF) will be included as a covered dental benefit in the MMC program for all ages. It is anticipated that utilization of SDF will be low in the near-term. In addition, effective January 1, 2018, coverage for tobacco cessation and counseling services will be a covered dental benefit. Based on information provided by ODM, coverage of SDF and tobacco cessation is estimated to be budget neutral.  ESRD Reimbursement Changes. Effective July 1, 2017, reimbursement for End-Stage Renal Disease (ESRD) clinics are based on the calendar year 2016 prospective payment system (PPS) base rate published by the Centers for Medicare and Medicaid Services (CMS). Reimbursement for services were established as follows: o Chronic maintenance dialysis performed in an ESRD dialysis clinic: 58.75% of PPS base rate; o Chronic maintenance dialysis performed in a home setting: 25.18% of PPS base rate; o Dialysis support services: 33.75% of PPS base rate; and, o Dialysis with self-care training: 67.75% of PPS base rate. We reviewed CY 2016 experience data for applicable services and believe that this program change is not material to the CY 2018 rate development process.

Advanced Imaging Reimbursement Changes. Effective January 1, 2017, ODM will modify its reimbursement policy for radiology services that occur when more than one radiology procedure is performed by the same provider or provider group for an individual patient on the same date. Based on prior analyses completed related to reimbursement refinements for radiology services, we did not make a program adjustment for this reimbursement change.

Advanced Imaging Reimbursement Changes. Effective January 1, 2017, ODM will modify its reimbursement policy for radiology services that occur when more than one radiology procedure is performed by the same provider or provider group for an individual patient on the same date. Payment for the primary procedure is made at 100% of the Medicaid fee schedule amount. Each additional professional component of the procedure will be reduced to 95% of the Medicaid fee schedule amount, compared to the prior policy of paying each additional professional procedure at 75% of the Medicaid fee schedule amount. • ESRD Reimbursement Changes. Effective April 1, 2017, reimbursement for End-Stage Renal Disease (ESRD) clinics will be based on the prospective payment system (PPS) base rate published by the Centers for Medicare and Medicaid services (CMS). Reimbursement for services will be established as follows: o Chronic maintenance dialysis performed in an ESRD dialysis clinic: 58.75% of PPS base rate; o Chronic maintenance dialysis performed in a home setting: 25.18% of PPS base rate; o Dialysis support services: 33.75% of PPS base rate; and, o Dialysis with self-care training: 67.75% of PPS base rate. We reviewed CY 2015 experience data for applicable services and believe that this program change is not material to the CY 2017 rate development process.

Advanced Imaging Reimbursement Changes. Effective January 1, 2017, ODM modified its reimbursement policy for radiology services that occur when more than one radiology procedure is performed by the same provider or provider group for an individual patient on the same date. Payment for the primary procedure is made at 100% of the Medicaid fee schedule amount. Each additional professional component of the procedure is reduced to 95% of the Medicaid fee schedule amount, compared to the prior policy of paying each additional professional procedure at 75% of the Medicaid fee schedule amount.  Dental Program Changes. Effective January 1, 2018, coverage for tobacco cessation and counseling services will be a covered dental benefit. Based on information provided by ODM, coverage of SDF and tobacco cessation is estimated to be budget neutral.  ESRD Reimbursement Changes. Effective July 1, 2017, reimbursement for End-Stage Renal Disease (ESRD) clinics are based on the CY 2016 prospective payment system (PPS) base rate published by the Centers for Medicare and Medicaid Services (CMS). Reimbursement for services were established as follows: o Chronic maintenance dialysis performed in an ESRD dialysis clinic: 58.75% of PPS base rate; o Chronic maintenance dialysis performed in a home setting: 25.18% of PPS base rate; o Dialysis support services: 33.75% of PPS base rate; and, o Dialysis with self-care training: 67.75% of PPS base rate. We reviewed CY 2016 experience data for applicable services and believe that this program change is not material to the CY 2018 rate development process.