Newsletter February 2018

Attention Managed Care Network Providers! 
Do not lose your participation with the major New York State payers Health First, Fidelis Care, Metroplus etc. 

The 21st Century Cures Act required all Medicaid Managed Care and Children's Health Insurance Program (CHP) network providers to be enrolled with State Medicaid programs. 

Do not wait until the last minute!
March 31st is the last day to report MIPS! 

If you report a minimum amount of 2017 data you can avoid a negative 4% payment adjustment.  Read more

Effective 4/1/2018, Universal Billing Codes for Home Care and Adult Day Health Care Services will be required! Any claims under contracts or agreements between any long term care providers and managed long term care plans or managed care plans are required to be processed using the universal standards for coding of payments. Read more

Changes to 2018 Clinical Laboratory Medicare Fee Schedule. Effective January 1, 2018, CLFS (Clinical Laboratory Fee Schedule) rates are based on weighted median private payor rates as required by the Protecting Access to Medicare Act (PAMA) of 2014.
These rates result in significant cuts in payment for rapid point-of-care testing services in physician office-based labs. Read more

EmblemHealth Payment Reductions on Medicare Claims. EmblemHealth began applying a two percent payment reduction (sequestration) on January 1,2018 on all professional and facility Medicare claims. Read more

Fidelis Care has contracted Performance Recovery, Inc to perform an audit!
Fidelis Care has contracted Performance Recovery, Inc to perform an audit of claims submitted by healthcare providers and paid by Fidelis Care plan.
As part of the audit process, it will be necessary to provide all requested documentation within 30 calendar days from the date of a notice. Performance Recovery, Inc gives an opportunity to submit the records by mail and fax as well as it can be sent as images on CD/DVD. If a provider fails to submit the records within the specified timeframe, the audit will be cited as a finding due to non-compliance. This denial will be ineligible for an appeal and that is why it is highly important to process the request immediately after receipt.
Contact your WCH account representative immediately if you received such notice!

Maria Chechina, Billing Department Specialist
Maria Chechina works with WCH for over 5 years as an Account Representative and became a valuable member of the team. Recently she passed AAPC examination and became a Certified Professional Coder.
That is plus to her previous CMRS certificate, which crowned her novice stage. Read More