Top Medical Billing Companies

Coordinated Care Provision

Starting with the 2017 open enrolment period, the administration will test a star rating system to mark plans sold on Federal HIEs in five states. This will expand to all states that use the Federal marketplace in 2018. Ohio, Michigan, Pennsylvania, Wisconsin, and Virginia are the states to test the system first.

Formally called QRS or Quality Rating System, this system was the result of effort begun in 2014, where comparable and useful information was collected to aid consumers with informed choice making while purchasing a plan on the marketplaces. CMS has also been surveying enrolees to assess their experiences. The five star system is meant to show how well doctors can coordinate in care provision, whether in-network providers get quality results, and the rating enrolees give their doctors.

On top of the QRS, open enrolment will see other major additions as well, namely Simple Choice Plans. These will have a uniform set of features for each metal tier, so consumers will find it easier to pick them. There will be a fixed deductible as well as standard co-payments inside each tier. This will give consumers less reason to compare plans, which means their choice is made simpler. The Simple Choice Plans will be sold in addition to the regular offerings, but they are not mandatory.

Medical Coding And Billing Online

Quality Rating System

A CMS blog post says that in order to boost decision making, these plans will be prominent in Plan Compare, and that there will be “clear visual cues” helping customers figure out which plans to compare. These consumers will also be able to filter the types of plans to see the ones that warrant comparison. These plans come with a fixed deductible and out-of-pocket limits, and are focused on the coverage of core services before the consumer reaches their deductible.

CMS is testing with display options and descriptions of these plans, allowing consumers an easy-to understand choice. The point to note here is that the approach does not block innovation, which means that health plans can keep giving all kinds of benefit options that consumers can find easily.

Most tools offered by CMS, including the physician and prescription drug lookup, and QRS, will collaborate with the plans cost comparisons while shopping, get the features they find valuable, such as a particular provider’s or plan’s experience with the management of chronic conditions.

Leave a Comment

Your email address will not be published. Required fields are marked *