Value-Added Services
- Vision Discount Program. WPS customers receive access to the EyeMed Vision Care discount program at no additional cost .
- Express Scripts Pulmonary Care Program. WPS customers can help control asthma or COPD with sensors that attach to their inhalers to monitor medication use.
- Active&Fit Direct ™ Program. ...
- ExerciseRewards ™ Program. ...
Full Answer
What are value-added services?
For this brief, we define “value-added services” as additional services outside of the Medicare and Medicaid benefit package (i.e., State Plan and/or Medicaid managed care contract) that are delivered at managed care plans’ discretion and are not included in capitation rate calculations. Value -added services seek to improve quality and
What is the $20 Value Added Service card?
H ealth plans integrating Medicare and Medicaid services may choose to provide additional “value-added” services for their dually eligible members, many of whom often have complex clinical conditions and functional limitations — as well as other social service and non-health related needs. Health plans are not paid to provide these additional services, but offer them in …
What value-added services are included in care management?
Congress occasionally adds specific services to be covered by Medicare. Some categories are defined more broadly than others; for example, the Act includes hospital outpatient services furnished incident to physicians’ services (§1861(s)(2)(B)) but also specifically includes diabetes screening tests (§1861(s)(2)(Y)). The Secretary . has
What are the value-added services at Superior HealthPlan?
Value Added Benefits Group Medicare Hearing Aid Coverage Medica members save on hearing aids and more with EPIC Hearing. Get 30–60% off manufacturer's suggested retail price (MRSP) on major hearing aid brands through EPIC Hearing Service plan. Call 1-866-956-5400(TTY:711) Available 8 a.m. – 6 p.m. Central, Monday–Friday
What are value-added services in healthcare?
Value-added services provide employers and health plans with an array of choices, such as: Adherence and disease management programs. Reimbursement assistance. Data products for payers and manufacturers.
What are value-added activities in a hospital?
Value-added (VA) refers to any work activity that contributes in a meaningful way to the patient's care provision (like a visit with a clinician) or information about that care (like test results). A step is value-added if it adds to the patient's care provision or information about that care.Apr 10, 2019
What are value based programs?
What are the value-based programs? Value-based programs reward health care providers with incentive payments for the quality of care they give to people with Medicare. These programs are part of our larger quality strategy to reform how health care is delivered and paid for.Mar 31, 2022
How does value based payment work?
Value Based Payment (VBP) is a concept by which purchasers of health care (government, employers, and consumers) and payers (public and private) hold the health care delivery system at large (physicians and other providers, hospitals, etc.) accountable for both quality and cost of care.
What are value-added activities examples?
Value-Added Activities are those that transform raw materials (plastic, lithium, copper) into the finished product (a smartphone) for which the customer is willing to pay. Some examples include molding, cutting, drilling or assembling parts.Jul 27, 2020
What are value adding support strategies?
The value adding support strategies are a part of the implementation strategies that accomplish the directional, adaptive, market entry, and competitive strategies and facilitate the accomplishment of the service delivery strategies.
What are value based services?
Value-based healthcare is a healthcare delivery framework that incentivizes healthcare providers to focus on the quality of services rendered, as opposed to the quantity. Under a value-based healthcare model, healthcare providers (including hospitals and physicians) are compensated based upon patient health outcomes.
How does value-based healthcare work?
Essentially, value based care models revolve around the patient's treatment and how well a coordinated care team can improve patient outcomes based on certain metrics, such as reducing hospital readmissions, improving preventative care, and using particular kinds of certified health technology.Apr 15, 2022
What is value based service delivery?
Page 1. Value-based healthcare is the equitable, sustainable and transparent use of the available resources to achieve better outcomes and experiences for every person.
Who benefits the most from value-based reimbursement?
Perhaps the primary way patients benefit from value-based care is that they will experience better health outcomes, not just in one isolated area of illness, but across the full spectrum of comorbidities and side effects that accompany their illness.Mar 26, 2021
What are the benefits of value-based healthcare?
Benefits of value-based care are lower costs, higher patient satisfaction, reduced medical errors, better-informed patients. There are six components, such as wide-spanning access to care, to an “ideal” high-value healthcare system.Nov 30, 2021
What factors are part of the CMS value-based programs?
What measures are used in the Hospital VBP Program?Mortality and complications.Healthcare-associated infections.Patient safety.Patient experience.Efficiency and cost reduction.Dec 1, 2021
What is Medicare Part B?
Medicare Part B covers individual and group therapy services to diagnose and treat mental illness. The Part B coverage usually requires a physician referral for mental health care and is based on a mental health diagnosis.
Who must provide acupuncture in MA?
The acupuncture provided by MA plans as a supplemental benefit must be provided by practitioners who are licensed or certified, as applicable, in the state in which they practice and are furnishing services within the scope of practice defined by their licensing or certifying state.
What is general nutrition education?
General nutritional education for all enrollees through classes and/or individual counseling may be provided as a supplemental benefit as long as the services are provided by practitioners who are practicing in the state in which s/he is licensed or certified, and are furnishing services within the scope of practice defined by their licensing or certifying state. (i.e., physician, nurse, registered dietician or nutritionist). The number of visits, time limitations, and whether the benefit is for classes and/or individual counseling must be defined in the PBP.
Does MA offer alternative therapies?
MA plans may offer alternative therapies as supplemental benefits. These alternative therapies must be provided by practitioners who are licensed or certified, as applicable, in the state in which they practice and are furnishing services within the scope of practice defined by their licensing or certifying state. MA plans are to provide a description of therapies offered in the PBP Notes section.
What is a non-SNP physical exam?
Non-SNP MA plans may offer as a supplemental benefit a physical exam that provides services beyond those services required to be provided in the Annual Wellness Visit. To be considered an Annual Physical Exam that qualifies as a supplemental benefit by CMS, the exam would be provided by a qualified physician or qualified non-physician practitioner, hereafter referred to as a practitioner. At a minimum, the exam would include a detailed medical/family history and the performance of a detailed head to toe assessment with hands-on examination of all the body systems. For example, the practitioner uses visual inspection, palpation, auscultation and 133 manual examination in his/her full examination to assess overall general health and detect abnormalities or signs that could indicate a disease process that should be addressed. We consider these components minimum elements and not an exhaustive list.
Does MA offer chiropractic care?
MA plans may choose to offer routine chiropractic services as a supplemental benefit as long as the services are provided by a state-licensed chiropractor practicing in the state in which he/she is licensed and is furnishing services within the scope of practice defined by that state’s licensure and practice guidelines. The routine services may include conservative management of neuromusculoskeletal disorders and related functional clinical conditions including, but not limited to, back pain, neck pain and headaches, and the provision of spinal and other therapeutic manipulation/adjustments.
What is post discharge reconciliation?
An MA plan may offer a post-discharge medication reconciliation as a supplemental benefit. For example, immediately following discharge (e.g., within the first week) from a hospital or SNF inpatient stay, MA plans may offer, as a supplemental benefit , the services of a qualified health care provider who, in cooperation with the enrollee’s physician, would review the enrollee’s complete medication regimen that was in place prior to admission and compare and reconcile with the regimen prescribed for the enrollee at discharge to ensure new prescriptions are obtained and discontinued medications are discarded. This reconciliation of the enrollee’s medications may be provided in the home and is designed to identify and eliminate medication side effects and interactions that could result in illness or injury.
Value-added Services by Product
At Superior HealthPlan, members can get many great services in addition to their regular benefits. These are called Value-added Services*. From extra vision care to cell phones and car seats, Superior is proud to offer many extra services to help keep our members healthy. For questions, contact Member Services.
Find a Provider
A big part of helping you and your loved ones be healthy and stay healthy is finding the right doctors. Use our Find a Provider tool to help find your care team.
Medicaid and CHIP Events
Superior wants you to have the best care possible. That’s why we offer classes at no cost. View our Medicaid and CHIP events.
What does "provider" mean in Medicare?
As used in this chapter, the term "provider" means all Medicare health plan/M+C organization contracting health care delivery network members; e.g., physicians, hospitals, etc. The purpose of this section is to specify what practices in this area meet both CMS requirements and the needs of the health plans/M+C organizations with respect to entities considered providers by health plans/MCOs. The CMS is concerned with provider marketing for the following reasons:
How long do you have to give notice of Medicare changes?
Cost plans must give notice within 30 days of the effective date of the Medicare program and health plan changes (i.e., by December 1 for January 1 changes). "Give notice" means that members must have received the notice by the required date. This notice is known as the "Annual Notice of Change," or "ANOC." The ANOC must be member specific. This means that the notice must have the member's own name either on the envelope addressed to the member or on the ANOC itself. The following is a model ANOC for M+C organizations and cost plans.
What is a lock in statement?
Lock-In Statement: The concept of "lock-in" must be clearly explained in all materials. For marketing pieces which tend to be of short duration we suggest: "You must receive all routine care from plan providers" or "You must use plan providers except in emergent care situations or for out-of-area urgent care/renal dialysis." However, in all written materials used to make a sale, a more expanded version is suggested: "If you obtain routine care from out-of-plan providers neither Medicare nor [name of health plan/M+C organization] will be responsible for the costs." Modify materials if the health plan has a Point-of-Service (POS) or Visitors' Program benefit or is a cost plan, Private Fee-For-Service Plan (PFFS) or PPO.
What is cost contracting health plan?
For §1876 of the Social Security Act, cost-contracting health plans only - In all marketing materials (e.g., brochure narratives and introductions to side-by-side comparisons) the health plan must indicate that it meets Medicare regulatory requirements for providing enrollment opportunity and benefit packages for both Part A and B and Part B-only eligible beneficiaries.4
How many pages can you put in a promotional booklet?
This section is limited to a maximum of four pages of promotional text and graphics and is not standardized with regard to format or content. The 4-page limit means that the information is limited to four single-sided pages or 2 double-sided pages. However, there are two exceptions to this limit:
Can M+C make changes to the benefit matrix?
M+C organizations are only permitted to make changes to the benefit matrix or Hard Copy Summary of Benefits on a limited basis. Any changes must be approved by CMS. Please refer to the Requests to Change Hard Copy Summary of Benefits for further detail.
What font size is required for Medicare?
All member materials that convey the rights and responsibilities of the health plan/M+C organization and the member must be printed with a 12-point font size or larger. Materials subject to this requirement include, but are not limited to, the EOC or member brochure and contract, the enrollment and disenrollment applications, letters confirming enrollment and disenrollment, notices of non-coverage (NONC) and notices informing members of their right to an appeals process. Due to the size of the member ID card, the member ID card need not have all information in a 12-point font size or larger. The CMS is cognizant of the fact that, when actually measured, font size 12 point may vary among different fonts with the result that some font types may be smaller than others. Times New Roman font type is the standard by which font size is measured. Therefore, if health plans/M+C organizations choose to use a different font type, it is their responsibility to ensure that the font used is equivalent to or larger than Times New Roman 12 point.
What is nominal value for Medicare?
The OIG defines “nominal value” as no more than $10 per item or $50 in the aggregate to any one beneficiary on an annual basis. “Nominal value” is based on the retail purchase price of the item. The Medicare anti-kickback statute states that it is a felony for a health care provider to knowingly and willfully offer or pay any remuneration ...
What does a DME supplier do?
The DME supplier must look at selling Medicare and non-Medicare covered items for cash. The supplier must look at providing products and services – not necessarily covered by Medicare – that will benefit the aging “Baby Boomers.”. And the supplier must offer “value-added” services to physicians and patients. In offering “value-added” services, the ...
How long has the DME industry been around?
AMARILLO, TX – The DME industry, as we know it today, has been around for about 40 years. It is a young industry. For the first 30 years of its existence, there was little government oversight on the industry. This has changed. Over the last 10 years, it feels like the government is making up for lost time. In short, the industry is caught in the “perfect storm” of (1) competitive bidding, (2) reimbursement cuts, (3) stringent documentation requirements, (4) aggressive auditors, and (5) proliferation of “whistleblowers.”
What is an iPad used for?
The iPads are to be used to collect and transmit data to the supplier. However, the physician’s employees are capable of using the iPads for personal use. • The DME supplier places several oxygen concentrators at the physician’s office. The physician uses the concentrators for in-office procedures.
Vision Discount Program
WPS customers receive access to the EyeMed Vision Care discount program at no additional cost .
Express Scripts Pulmonary Care Program
WPS customers can help control asthma or COPD with sensors that attach to their inhalers to monitor medication use.
Comparison Charts for Members Living in a Nursing Home or Facility
Find the area where you live. Then, pick the STAR+PLUS services that apply to your type of coverage – Medicaid Only or Medicaid and Medicare.
Comparison Charts for Members NOT Living in a Nursing Home or Facility
Find the area where you live. Then, pick the STAR+PLUS services that apply to your type of coverage – Medicaid Only or Medicaid and Medicare.
Comparison Charts for Members living in a Medicare-Medicaid Dual Demonstration County
Find the county where you live. Then, pick the chart for that county. Each chart includes tables for Members living in a nursing home or facility and for Members living in the community.
