E Interventions
E Interventions are patient interventions that help manage a patient's health care and/or health which:
- typically do not receive reimbursement from traditional health insurance
- likely will improve patient outcomes and reduce overall cost
These interventions typically don’t qualify for Medicare Part A (hospital), Part B (physician), Part C (Medicare Advantage) or Part D (medications) direct reimbursement. They can be described as Medicare Part E Interventions as there are no Medicare Part E reimbursements or "E - none of the above".
The types of "E Interventions" include:
- E Intervention Programs - team-based patient focused programs designed to meet specific needs of patients based on the program's criteria. These programs are integrated with the patient's care plan continuing for either for a duration or as long as the patient meets the criteria. The criteria includes risk scores, episode, health conditions and determinants.
- E Intervention Services - a specific focused services or capabilities designed to meet specific needs of patients based on the services's criteria. These services may or not be integrated with the patient's care plan or with an E Intervention Program. The criteria includes risk scores, episode, health conditions, E Intervention Program enrollment and determinants.
Most health plans are based on Medicare fee schedules, so they typically do not provide reimbursement for E Interventions. E Interventions may be delivered exactly the same way as clinical interventions that get reimbursed (like home health), yet they come with stipulations that may not suit the patient's situation. For example, a patient needs to stay 3 nights in a hospital to qualify reimbursement for home health services. If home health services are provided, they may not be reimbursed even if it is what the patient needs to improve their recovery. Another example is a physician speaking on the phone to their patient, which typically do not receive reimbursement for the physicians's time.
