HEALTHCARE NEWS

 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...

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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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...

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...

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...

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...

The Centers for Medicare & Medicaid Services (CMS) has modernized the National Plan and Provider Enumeration System (NPPES) with a unified login for type 1 and type 2 providers which increases security, provides new surrogacy functionality, has a more responsive user interface (UI) and...

In a study report about how “Improper Payments for Evaluation and Management Services Cost Medicare Billions in 2010,” the Office of the Inspector General (OIG) noted 42 percent of claims for Evaluation and Management (E/M) services were incorrectly coded and 19 percent la...

All Providers Must Revalidate Medicare Enrollment Information under Affordable Care Act Criteria Every Five Years; WCH Can Help With Provider Enrollment Revalidation – Cycle 2   In order to maintain Medicare billing privileges, all enrolled providers and suppliers must r...

National Government Services (NGS) is reporting an increase in documentation submitted without valid provider signature identification. This leads to claim denials that require time-consuming appeals. All medical records must have either a written or electronically entered provider sig...

Differentiation in examination requirements for Expanded Problem Focused (EPF, 2-5) and Detailed (6-7) levels of service developed by the National Government Services (NGS) will no longer be considered mandatory as of 7/1/2017. This delineation of levels, initiated in response to provider queries a...