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eMedicare and Creating a Better Customer Experience Through Innovation and Technology

The Centers for Medicare & Medicaid Services (CMS) is rolling out their eMedicare initiative which aims to improve their various customer service channels including their toll-free number and most importantly, their website.

Providing a seamless online customer experience is becoming an expectation with new Medicare beneficiaries. However, doing so provides benefits for everyone involved. “Our intent is not to replace traditional channels that beneficiaries trust and depend on, but to improve and enhance them with the emerging digital options to create a user-centered, seamless consumer experience,” said CMS Administrator Seema Verma.

Some of the changes that beneficiaries will experience include:

  • A coverage wizard so beneficiaries can decide whether Original Medicare or Medicare Advantage is best for them.
  • A mobile-optimized out-of-pocket calculator to help assess overall costs and prescription drug costs.
  • A web chat option available when in the Medicare Plan Finder.

When we look at this from the healthcare service side, a big improvement will be with Local Coverage Determinations (LCDs) which are made by the area Medicare Administrative Contractor (MACs) jurisdictions. Through changes to the LCDs, CMS wants to improve transparency and clarify as well as simplify processes. Doing so should help to get the right therapies, devices and new medical technologies to patients faster and more efficiently.

Coverage decisions will become more transparent. “This is just the beginning of our efforts to further accelerate medical innovation, improve the quality of care and lower costs for our beneficiaries,” said Verma.

With this new eMedicare initiative, there are changes to the Medicare Program Integrity Manual, one of which is reworking the format to become more of a “roadmap” for the process of LCDs. It is important to understand all the changes to the manual which are found here however, there are several that are worth noting right away.

  • The requirement for a consistent and standardized summary of all clinical evidence that supports LCD decisions.

Why this is important: This is a critical component of transparency and helps health service providers as well as beneficiaries to understand the reasoning behind the medical necessity decisions that are made.

  • Now including healthcare professionals like nurses and social workers in addition to physicians on Contractor Advisory Committees (CACs) that inform LCDs as well as including beneficiary representatives.

Why this is important: Offering beneficiaries and more levels of healthcare providers a seat a the table creates better buy-in from these key players.  The CAC’s are better informed with real “on the ground” insight that is incredibly valuable and may not be otherwise known. This, in turn, provides accurate medical information used in the  LCD’s outcomes which can be a win-win for everyone.

  • Opening meetings in MAC jurisdictions to the public.

Why this is important: These meetings can help healthcare providers to understand proposed coverage, their rationale, and the detailed evidence-based decisions.

In the end, we all want a better understanding of our medical care and through strengthening the systems that disseminate information about Medicare coverage. Automation can make the process easier to use and understand, and in turn, create a better patient experience. This type of progress through technology will and should continue. Make sure your systems keep up with the available technology, so your organization is not left behind.

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Related: Policy and Procedure Development and Implementation