Starting 05/01/21- EmblemHealth (NY) will offer the EmblemHealth Chronic Kidney Disease (CKD)/End Stage Renal Disease (ESRD) program.
What will this mean for your patients?
EmblemHealth team of care managers, social workers, and pharmacists may be in touch with the physician’s office as they coordinate patient care.
EmblemHealth is going to manage members affected by kidney disease
What will the EmblemHealth CKD/ESRD program do?
The CKD/ESRD program will provide eligible members with holistic, seamless and, clinically robust wrap around support throughout all stages of their health care journey
What is the purpose of EmblemHealth CKD/ESRD Care Management Program?
EmblemHealth’s CKD/ESRD program aims to slow the progression of illness and reduce unnecessary utilization. The program seeks to improve condition management and navigation of the healthcare system through a structured approach to person-centered assessment, care planning, and delivery of interventions.
Who will select the patents?
EmblemHealth will identify members with complex needs and provide them with individualized care management interventions.
How to get in touch with EmblemHealth CKD/ESRD Care Management Program Staff?
For more information or to make a referral, call us as at 800-447-0768, Monday through Friday, 9 a.m. to 5 p.m.
Full Name of this policy is: Multiple Procedure Reduction on the Technical Component of Diagnostic Cardiovascular and Ophthalmology Procedures Payment Policy
Effective Date is February 03/2021
This policy will follow the reimbursement standards set forth by the CMS, under the MVP Multiple Procedure Payment Reduction (MPPR) policy. The MPPR policy regarding diagnostic cardiovascular and ophthalmology procedures apply when multiple services are furnished to the same patient on the same day. The MPPR policy applies independently to cardiovascular and ophthalmology services. The MPPR policy applies to TC-only services, and to the TC of global services.
For cardiovascular services: 100% reimbursement is made for the TC service with the highest payment. Reimbursement is made at 75% for subsequent TC services furnished by the same physician (or by multiple physicians in the same group practice, i.e., same Group National Provider Identifier (NPI)) to the same patient on the same day.
For ophthalmology services: 100% reimbursement is made for the TC service with the highest payment. Reimbursement is made at 80% for subsequent TC services furnished by the same physician (or by multiple physicians in the same group practice, i.e., same group NPI) to the same patient on the same day. The MPPR policy does not apply to the professional component.