HEALTHCARE NEWS

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...

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 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...

To simplify the healthcare experience and reduce the administrative burden on healthcare providers, UnitedHealthcare is introducing a groundbreaking initiative: the National Gold Card program. Set to officially launch on October 1, 2024, this program represents a major step forward in modernizing th...

On August 16, 2024, Humana Inc. agreed to a $90 million settlement after a whistleblower lawsuit claimed the company overcharged Medicare for prescription drugs. Filed by former Humana actuary Steven Scott, the lawsuit exposed major issues within Medicare Part D and highlighted important takeaways f...

Healthcare organizations have increasingly focused on addressing social determinants of health (SDOH) to improve patient outcomes and reduce healthcare costs. SDOH refers to non-medical factors like income, education, environment, employment, and social networks that heavily influence a person’...

 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...

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...