HBO's The Wire Should Highlight Maryland's Health Care System

As outreach efforts intensify in the last three weeks before Open Enrollment on state healthcare marketplaces, many states worry that their uninsured populations won't receive the message.  Maryland is one state that worries about whether it can successfully enroll its state's 800,000 uninsured residents.

One of the main issues reaching Maryland's uninsured is the lack of available data to help state officials locate those residents. In an effort to change this, officials are using "upgraded electronic health records to develop maps highlighting where Marylanders overuse emergency rooms for care -- one indicator of the uninsured -- or where pockets of disease develop."  (Baltimore Sun, 9/7/13.)  While census data can identify concentrations at the city and county levels, this improved data will provide more targeted information that will help identify demographics down to the community level.

[dhmh.maryland.gov]

Once communities with high numbers of uninsured are identified, state and community health leaders plan to target "pharmacies, grocery stores, and street festivals" to find those in need of care and inform them of their options.

This new data is important because enrollment in Medicaid under health care reform's expansion allowance could make or break the success of the new law which requires high levels of enrollment in order to succeed. New data identifying smaller pockets of uninsured will make targeted education efforts possible, which may, in turn, generate enrollment.

[deathandtaxesmag.com]

With all these changes and data challenges afoot, perhaps Maryland's health care system would make a fascinating theme for The Wire, should producers decide to shoot an encore season.  It may be yet another way to educate communities about burgeoning health care options. And I'm sure its 4 million viewers wouldn't be disappointed, either.

Providers May Need To Re-Enroll To Get Medicare Reimbursements

New Medicare enrollment requirements for medical providers and suppliers may post serious billing issues if applications are not filled out properly and timely.

[amberusa.com]

Section 6401 (a) of the Affordable Care Act established a requirement for all Medicare-enrolled providers and suppliers to revalidate their enrollment information under new enrollment screening criteria. This revalidation effort applies to those providers and suppliers that were enrolled prior to March 25, 2011. Newly enrolled providers and suppliers that submitted their enrollment applications to CMS on or after March 25, 2011, are not impacted. 

One Kansas health department suffers the consequences of an untimely revalidation application.  The Lawrence-Douglas County health department is currently unable to bill Medicare for healthcare services it provides to seniors.  This self-proclaimed "personnel issue" has already cost the department upwards of $6,000.  

Between now and March 23, 2015, MACs will send out notices on a regular basis to begin the revalidation process for each provider and supplier. Providers and suppliers must wait to submit the revalidation only after being asked by their Medicare Administrative Contractor (MAC) to do so. Please note that 42 CFR 424.515(d), part of the rules issued by CMS under its rulemaking authority, provides CMS the authority to conduct these off-cycle revalidations.