Care Coordination - Medicare Pilot Program for Asbestos Related Disease

The Medicare Pilot Program for Asbestos Related Disease (MPPARD) focuses on providing comprehensive care coordination for beneficiaries with asbestos-related conditions. Overall, care coordination under MPPARD is highly organized and beneficiary-centered process that aims to provide comprehensive support for individuals with asbestos-related diseases, ensuring they receive the care they need while maintaining clear communication among all parties involved.

1. Assessment of Needs
2. Individualized Care Plans
3. Ongoing Coordination
4. Program Oversight and Medical Advice
5. Documentation and Support
6. Claims Review and Input

Assessment of Needs

Care coordination activities will be carried out by various Noridian MPPARD staff, with primary responsibility resting on our nursing team. Our nurses, who are well-versed in clinical and nursing practices, will work directly with beneficiaries to evaluate their medical and care needs related to asbestos-related diseases (ARD).

This assessment may be conducted via phone calls or, if necessary, through face-to-face meetings, which could take place in the beneficiary's home or another suitable location.

Individualized Care Plans

Once the beneficiary's needs have been assessed and all requirements are met, the nurse writes an individualized authorization for services. This plan is based on medical necessity, customized to the beneficiary's specific needs and medical requirements.

Ongoing Coordination

Care coordination is continuous and adapts to changing health conditions. As the beneficiary's needs change, we ensure they receive the appropriate care and services to match their evolving condition.

Care coordinators ensure all pertinent information is shared between healthcare providers, beneficiaries, and their families as needed to promote smooth and effective care delivery.

Program Oversight and Medical Advice

Medical directors oversee the program to ensure high-quality care and offer guidance for care coordination when needed. This ensures that the medical aspect of care is well-managed and adheres to best practices.

Documentation and Support

All care coordination activities are thoroughly documented. This documentation is essential for MPPARD staff to assist providers and beneficiaries with any questions they might have, ensuring there is transparency and continuity of care.

Claims Review and Input

Care coordinators are also involved in the review of claims submitted to MPPARD. They assess whether the services provided are reasonable and necessary and eligible for reimbursement under the program.

Additionally, care coordinators may provide input on the appropriateness of services or treatment before they are provided, ensuring that only medically necessary and effective treatments are pursued.