The right of an enrollee to appeal an at-risk determination will also have an associated cost. As explained, we estimate a total hourly burden of 178 Start Printed Page 56481hours at an annual estimated cost of $35,183 in 2019. As previously discussed, we estimate that 1,846 beneficiaries would meet the criteria for being identified as an at-risk beneficiary. Based on validated program data for 2015, 24 percent of all adverse coverage determinations were appealed to level 1. Given the nature of drug management programs, the extensive level of case management conducted by plans prior to making the at-risk determination, and the opportunity for an at-risk beneficiary to submit preferences to the plan prior to lock-in implementation, we believe it is reasonable to assume that this rate of appeal will be reduced by at least 50 percent for at-risk determinations made under a drug management program. Therefore, this estimate is based on an assumption that about 12 percent of the beneficiaries estimated to be subject to an at-risk determination (1,846) will appeal the determination. Hence, we estimate that there will be 222 level 1 appeals (1,846 × 12 percent). We estimate it takes 48 minutes (0.8 hours) to process a level 1 appeal. There is a statutory requirement that a physician with appropriate expertise make the determination for an appeal of an adverse initial determination based on medical necessity. Thus, we estimate an hourly burden of 178 hours (222 appeals × 0.8) at a cost of $197.66 per hour for physicians to perform these appeals. Thus the total cost in 2019 is estimated as $35,183 = 178 hours × $197.66.
See the story Freestanding Radiology Providers Or, enter your zip code to shop online Guests of all ages enjoy free apple picking and activities. First 500 guests receive a free BCBSVT "Pick a Peck" bag to fill with fresh, delicious apples! One bag per person - limit 4 per family.
Toy Safety Ready to engage with Excelsior? Keep reading opens in a new window Mental health reports Join AARP
Early Medicare poster from ssa.gov Enhanced Content - Document Print View ++ Delete § 422.204(b)(5) because it applies to the Part C enrollment process, which we are proposing to eliminate. Further, revising paragraph (b)(5) to address the preclusion list requirements could cause confusion, for paragraph (b) references providers and suppliers. We thus believe that creating a new paragraph (c) would better clarify our expectations.
IBD Newsletters Episodes Once I click on a link to visit a Blue365 vendor's website, the fact that I am enrolled in an Arkansas Blue Cross product will be disclosed to that vendor. Although Arkansas Blue Cross will not give the vendor my name or any other information about me, I understand that the vendor may not be subject to federal health information privacy laws and, therefore, could re-disclose the fact that I am enrolled in an Arkansas Blue Cross product (subject to vendor's own privacy policies and any applicable state laws).
Call 612-324-8001 Medical Cost Plan | Minneapolis Minnesota MN 55426 Hennepin Call 612-324-8001 Medical Cost Plan | Minneapolis Minnesota MN 55427 Hennepin Call 612-324-8001 Medical Cost Plan | Minneapolis Minnesota MN 55428 Hennepin Legal | Sitemap