HEALTHCARE NEWS

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...

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...

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...

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...

New Medicare cards, which will begin mailing in April 2018, will no longer include Social Security numbers. This Centers for Medicare & Medicaid Services (CMS) fraud prevention initiative will help combat identity theft and safeguard taxpayer dollars.The new cards will use a unique, randomly-ass...

Effective January 1, 2016, the New York telehealth coverage law prohibited commercial insurers and health maintenance organizations from “excluding from coverage a service that is otherwise covered under an enrollee contract because the service is delivered via telehealth.” (NY State Pu...

All providers must report enrollment information changes to their Medicare Administrative Contractor (MAC) within 30 days for a change in ownership, an adverse legal action, or a change in practice location, or 90 days for all other changes. Failure to do so could result in the revocation of your Me...

Effective July 1, 2017, the Centers for Medicare & Medicaid Services (CMS), in partnership with the New York State Office of the Medicaid Inspector General (OMIG), will be measuring improper payments in the Medicaid and State Child Health Insurance programs under the Payment Error Rate Measureme...

Retroactive to July 1, 2016, Medicaid will no longer reimburse the full Medicare Part C copay or coinsurance amount.Pursuant to 2016 changes to Social Services Law, the New York State Department of Health has revised the Medicaid reimbursement methodology for claims containing Medicare Part C (Medic...

The Commissioner of Health has approved a new blanket waiver with respect to the electronic prescribing requirements of Public Health Law (PHL) § 281 and Education Law § 6810. Effective March 26, 2017, this waiver replaces and supersedes the prior blanket waiver, issued by letter dated Mar...