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Calia Venice is correct that “any doctor could legally prescribe any medicine they are comfortable prescribing. Most wouldn’t feel comfortable prescribing medications that are out of their area of expertise.” Many family physicians and geriatricians have prescribed psychotropics drugs in the narrow sense of antipsychotics. Fortunately that practice is declining.Just as DEA redefined the word narcotic, CMS has redefined psychotropic. In November 2017 CMS decreed that the definition of a psychotropic medication is“any drug that affects brain activities associated with mental processes and behavior.”1 These drugs include, but are not limited to, the following drug categories: antipsychotic, antidepressant, antianxiety, hypnotic, as well as medication classes that may affect brain activity. This expanded list of psychotropic medications includes central nervous system agents, mood stabilizers, anticonvulsants, muscle relaxants, anticholinergic medications, antihistamines, N-methyl-D-aspartate receptor modulators, and over-the-counter natural or herbal products.1https://www.managedhealthcareconnect.com/article/new-cms-rules-psychotropic-medications-snfs1. Centers for Medicare & Medicaid Services (CMS). Revision to State Operations Manual (SOM) appendix PP for phase 2, F-tag revisions, and related issues, Section F757. CMS website. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/Guida.... Accessed November 10, 2017.Given the new, incredibly broad, range of psychotropic drugs, many family physicians, internists, and pediatricians routinely prescribe these.

Hello!I can answer that for you.Watch out, older Americans and people with disabilities! Donald Trump just announced a plan to give corporate health insurers more control over your health care. His new executive order calls for “market-based” pricing, which would drive up costs for everyone with Medicare, eviscerate traditional Medicare, and steer more people into for-profit “Medicare Advantage” plans.Seema Verma, the Trump appointee who heads the Centers for Medicare and Medicaid Services (CMS), may not have warned Trump about the slew of government audits revealing that many Medicare Advantage plans pose “an imminent and serious risk to the health of… enrollees.” They also overcharge taxpayers to the tune of $10 billion a year.In the last few years alone, CMS’ limited audits have highlighted major issues with Medicare Advantage plans. Reports from the Department of Health and Human Services Office of the Inspector General (OIG) and Government Accountability Office (GAO) have underscored these issues. They have recommended that CMS increase its oversight of Medicare Advantage plans and its enforcement efforts.A Medicare Payment Advisory Commission report indicates that the problems with Medicare Advantage may be even more far-reaching than the government audits indicate. The Medicare Advantage plans have failed to turn over reliable and complete claims data, as required by law. Without this data, it’s not possible to know whether they are covering the health care services they are paid to provide or to oversee them to the extent necessary.Last month, Senators Sherrod Brown, Amy Klobuchar, Chris Murphy, Richard Blumenthal, Bernie Sanders and Debbie Stabenow laid out several serious malfeasances by these corporate Medicare insurers—including UnitedHealth Group, Aetna, Cigna and Humana—in a detailed letter they sent to Verma.The insurers’ wrongdoings are systematic. They are ongoing. They endanger the health and financial well-being of millions of people. They undermine the financial integrity of the Medicare program and harm the U.S. Treasury. Yet, to date, CMS has failed to develop, let alone execute, a plan to hold these insurers accountable for violating their legal obligations and to ensure their members get the health care to which they are entitled.Tens of billions in overcharges are one big problem. Medicare Advantage plans have been overcharging the government for their services for many years now, by claiming that their members are in worse health than they actually are in order to increase payments. To make matters worse, they have refused to pay back the tens of billions in overpayments that the federal government has made to them. UnitedHealth successfully fought to keep the government from collecting this money.Another major concern is that Medicare Advantage plans are failing to cover the care their members need and are entitled to. Government audits show that Medicare Advantage plans are inappropriately delaying and denying care and coverage to hundreds of thousands (if not millions) of their members. This puts patients’ health and safety at risk. Thousands of people end up paying for care that should have been covered—or foregoing care altogether.CMS has not named or flagged these corporate health plans on its Medicare website or notified people in any other way of plans with serious violations, as it had agreed to do at the recommendation of the Office of the Inspector General. So, people with Medicare are unaware when they enroll in a Medicare Advantage plan that the government has found to be jeopardizing the health and safety of its members. Instead, CMS continues to give four- and five-star ratings to some of these health plans. In the process, it misleads older adults and people with disabilities about their performance.What’s more, CMS has found that a sizeable number of Medicare Advantage plans have for years issued highly inaccurate provider directories; and, the GAO has noted “concerns about ensuring enrollee access to care.” Many of these health plans have narrowed their provider networks. GAO suggests that it is not at all clear which of these Medicare Advantage plans have an adequate number and mix of health care providers in their networks.To date, the Trump administration has been steering people into Medicare Advantage plans, without regard to their deficiencies. And, it has failed to provide people with Medicare with meaningful information about their health plan choices as required by law. It is on a reckless path, promoting the business interests of Medicare Advantage plans that violate the law over the health care needs of vulnerable Americans.The administration and its congressional allies are playing a game of bait and switch with older adults and people with disabilities. They allow Medicare Advantage plans to lure people with benefits that traditional Medicare does not offer, such as dental care and transportation services to the doctor, without exposing their failings. The Trump administration’s goal is to fully privatize Medicare and shift more costs onto older and disabled Americans.To be clear, Trump’s executive order does nothing to hold the Medicare Advantage plans accountable for their fraudulent overcharges or their inappropriate denials of care and coverage. Rather, it rewards them. It gives them even more discretion regarding the services they cover and the freedom to create new bells and whistles to lure in members. The health and financial well-being of older and disabled Americans hangs in the balance.This answer is attributed to: The White House Centers for Medicare & Medicaid Services Watch Out, Seniors! Trump Just Launched a Stealth Attack on Medicare U.S. Government Accountability Office (U.S. GAO) shorten that long URL into a tiny URL U.S. Senator for Ohio An Official Website of the United States Government Healthcare News | Hospital News | Healthcare Companies | Fierce Healthcare Office of Inspector General Axios Breaking News, World News & Multimedia

In US health Care terminology, Provider is individual doctor or facility or Hospital that offers medical services to US citizens. Payer is organisation which takes care of financial and operational aspects (which include insurance plans, provider network) of providing health care to US citizens.I try to illustrate using simple use case:Bill is a citizen of US and he wants him to be insured from any medical emergencies or hospital costs. So, he visits a Payer website(Insurer) and looks at various health plans offered by him and kind of provider network he had. He may also visit health plan market place(Online platform where he can compare various health plans offered by different payers in his state). Now he will choose health plan that is in his best interest and accepts to pay fixed premium monthly or annually. Now suddenly Bill got Heart attack and his son Jack wanted him to be treated. Jack will take his father to a doctor named Richard in a hospital(Provider). Richard will treat Bill and takes care till he get discharged. All the expenses that happened in this process will be recorded and sent to Payer(Insurer) for the process of reimbursement. Payer will consider his claim and may choose to pay full or partly as per the terms between Payer and Provider.So, Payer side is nothing but the business aspects that are related to enrolling a member, offering health plan & provider network, verifying claims sent by providers, dealing with appeals, making payments to providers, use variety of softwares to track member health, predict member’s risk and manage therir healthcare utilisation, interacting with state health care or CMS to get reimbursements related to Medicaid or Medicare etc.Provider side is nothing but signing contract with various such payers, managing patients and providing medical services that required, checking with payers related to kind of services offered(pre-authorisation), interacting with medical coders to convert all recorded services to standard format, interacting with clearing houses to send claims to respective payers and manage the billing, checking for the amount that is reimbursed and making appeals if it is not fully reimbursed etc….Hope this helps!! :).PS