Updates on Medicaid-eligible members and members with cost-share protection
Each provider plays a critical role in Devoted Health’s network and in the delivery of high quality healthcare services to our members. In accordance with the Centers for Medicare & Medicaid Services (CMS) regulations and provider agreements, we're sharing reminders about members with Medicaid and cost-share protections:
Members who have coverage under the Qualified Medicare Beneficiary (QMB) program are not responsible for cost shares for Medicare services.
If a member is identified as having additional or secondary insurance coverage through Medicaid, providers should obtain a copy of the member’s Medicaid card to bill Medicaid after receiving the Remittance Advice (RA) from Devoted Health.
No cost shares (copayments, coinsurance, or deductibles) should be collected or billed at the time of the visit from a member with Medicaid coverage.
Members who are eligible for both Medicare and Medicaid cannot be held liable for Medicare Part A and B cost-sharing when the state is responsible for paying such amounts. Providers must either accept the payment amount from Devoted Health as payment in full, or bill the appropriate state source.
Learn more about member cost-sharing, balance billing and inappropriate billing of members, and coordination of benefits.
Glycemic Status Assessment for Patients With Diabetes (GSD)
For 2024, the Hemoglobin A1c Control for Patients with Diabetes (HBD) measure has been revised:
Renamed Glycemic Status Assessment for Patients With Diabetes (GSD)
In addition to the most recent A1c, the most recent glucose management indicator (GMI) can now be used
Kidney Health Evaluation for Patients With Diabetes (KED)
Members that fall into the KED measure need 2 tests: 1 estimated glomerular filtration rate (eGFR) test and 1 urine albumin-creatinine ratio (uACR) test to successfully close their gap.
CAHPS survey updates
Q2 Provider Scorecards are available
Provider scorecards assess performance on 4 key CAHPS measures and offer a comprehensive view for improvement. Updated panel lists help identify patients for education and appointments, aiming to schedule 30% for necessary education. Contact your network managers for a full review.
Survey fielding comes to a close
The official CAHPS survey fielding concluded on June 2nd. The feedback collected will be instrumental in enhancing the quality of care we provide. The results of the CAHPS survey will be available later this fall.
HCC risk adjustment model change
The Hierarchical Condition Category (HCC) risk adjustment model is used by CMS to predict prospective healthcare costs and resource needs of patients. The newest risk adjustment model, the V28, is being phased in through a blended model. Scoring for 2024 will be 67% V28 and 33% V24, shifting to 100% V28 in 2025. The V28 model introduces new HCC mappings for over 200 ICD-10 codes, including severe-persistent asthma, anorexia and bulimia nervosa, and post-polio syndrome. It also removes mappings for over 2,000 codes, such as peripheral vascular disease, senile purpura, angina, and malnutrition.
CMS emphasizes Part D and proper chronic condition management for improved patient outcomes. Complete and accurate documentation can help ensure the member’s true clinical picture is painted, and in turn the resources needed to care for the member are allocated appropriately.
Visit our resources section in Availity to access our Tips Sheets including our Tip Sheet on common documentation and coding errors.
CMS released FAQs on 4 health-related social needs services in the CY 2024 physician fee schedule to address Medicare beneficiaries' social needs.
1. Caregiver training services (CTS) 2. Social determinants of health risk assessment (SDOH RA) 3. Community health integration (CHI) 4. Principal illness navigation (PIN)
The Centers for Medicare & Medicaid Services (CMS) requires that all contracted providers who provide services to our SNP members receive the Model of Care training annually. We kindly request that your organization review our 2024 Model of Care and ensure that it is shared with all providers responsible for delivering care to SNP members throughout the year.
We’re partnering with a new payment integrity vendor
To ensure the highest accuracy of claim payments, we’re expanding our payment integrity programs in Q3 by partnering with a vendor partner that is an industry expert in genetic testing and infectious disease. Expect to receive edits on related claims from our vendor partner on a pre-pay basis. Requests from our vendors should be accepted as valid requests for Devoted Health.
Is there someone in your office who should get this newsletter?
Call us at 1-877-762-3515 (TTY 711) 8am to 5pm, Monday to Friday local time. We’re here to help.
CONFIDENTIAL - For provider use only. Not to be shared with Medicare beneficiaries.
Enrollment may be limited to specific times of the year, unless you qualify for a Special Election Period. Benefits, premiums, and cost sharing may vary by plan.
Devoted Health, Inc., PO Box 211037, Eagan, MN 55121
