HEALTHCARE NEWS

In recent years, healthcare stakeholders have increasingly turned their attention to addressing social determinants of health (SDOH) as a means to improve health outcomes and reduce overall healthcare costs. SDOH refer to the non-medical factors that influence health outcomes, such as socioeconomic ...

 The New York State Public Health Law has been amended to require universal standards for coding of payment for home and community based long term care services claims. Specifically, it requires these codes to be based on universal billing codes approved by the Health Department and be con...

Merit Based Incentive Payment System (MIPS) eligible providers who fail to collect and report a minimum amount of 2017 performance data by March 31, 2018, could face a four percent negative payment adjustment on Medicare reimbursements in 2019 — with increasing penalties in the future.
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 In 2013, the Centers for Medicare & Medicaid Services (CMS) reduced premium payments to health plans, providers and suppliers by two percent as a result of cuts in federal spending. This reduction is known as sequestration. EmblemHealth did not implement the reductions across the ...

In the guidance, were addressed some of the more frequently asked questions about when it is appropriate under the Privacy Rule for a health care provider to share the protected health information of a patient who is being treated for a mental health condition.  The guidance clarifies when ...

 CMS is committed to implementing the Medicare program in accordance with all applicable laws and regulations, including timely claims processing.  Several Medicare legislative provisions affecting health care providers and beneficiaries recently expired, including exceptions to the outpat...

Merit Based Incentive Payment System (MIPS) eligible providers who fail to collect and report a minimum amount of 2017 performance data by March 31, 2018, could face a four percent negative payment adjustment on Medicare reimbursements in 2019 — with increasing penalties in the futur...

Beneficiaries who use covered Part A services may be subject to deductible and coinsurance requirements. A beneficiary is responsible for an inpatient hospital deductible amount, which is deducted from the amount payable by the Medicare program to the hospital, for inpatient hospital servi...

Patients Over Paperwork  CMS has recently launched the “Patients Over Paperwork” Initiative, a cross-cutting, collaborative process that evaluates and streamlines regulations with a goal to reduce unnecessary burden, increase efficiencies, and improve the beneficiary experi...

Recently, health care providers have started receiving letters from the New York State Workers’ Compensation Board. Workers’ Compensation Board has initiated a registration process to update and maintain a list of medical providers who are authorized to treat injured workers.
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Effective January 1, 2018, Federal law requires that all Medicaid Managed Care and Children´s Health Insurance Program network providers to be enrolled with State Medicaid program. Enrollment applications must be submitted to the Medicaid by December 1, 2017. Providers have less than 3...

Physician’s services involved in physician certification (and recertification) of Medicare-covered home health services may be separately coded and reimbursed.  It is important to understand that the services are only covered for patients who receive Medicare-covered home health ...

Fidelis Care has engaged eviCore Healthcare (eviCore) to implement a new prior authorization program effective October 1, 2017.   Prior authorization will be required for the following services: Outpatient high-tech Radiology services Outpatient Non-Obstetrical Ult...

Certified electronic health record technology (CEHRT) is required to participate in the advancing care information performance category. MIPS-eligible clinicians and groups may qualify for a reweighting of their advancing care information performance category score to 0 percent of the fina...

Beginning January 1, 2017, prolonged services without face-to-face contact are now separately payable under the Medicare Physician Fee Schedule. Prolonged services without face-to-face contact do not require face-to-face time with the patient, and may be rendered in an office, outpatient, hospi...