HEALTHCARE NEWS
Stay Informed: Latest Updates and Insights in Healthcare
Medicare Deductible, Coinsurance, Premium Rates and Therapy Cap Values for Calendar Year 2018
2/7/2023
Medicare Deductible, Coinsurance, Premium Rates and Therapy Cap Values for Calendar Year 2018
Background
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 dedu...
New HIPAA guidance clarifies Sharing Information Related to Mental Health
2/7/2023
New HIPAA guidance clarifies Sharing Information Related to Mental Health
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 ...
Attention Medicare Physical Therapists (PT), Occupational Therapists (OT), Speech and Language Pathologists (SLP)
2/7/2023
Attention Medicare Physical Therapists (PT), Occupational Therapists (OT), Speech and Language Pathologists (SLP)
CMS is committed to implementing the Medicare program in accordance with all applicable laws and regulations, including timely claims processing. Several Medicare legislative provisio...
EmblemHealth Payment Reductions on Medicare Claims!
2/7/2023
EmblemHealth Payment Reductions on Medicare Claims!
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 n...
Effective 4/1/2018, Universal Billing Codes for Home Care and Adult Day Health Care Services will be required!
2/7/2023
Effective 4/1/2018, Universal Billing Codes for Home Care and Adult Day Health Care Services will be required!
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 r...
Do not wait until the last minute!
2/7/2023
Do not wait until the last minute!
March 31st is the last day Eligible professional may report MIPS measures and avoid 4% negative payment adjustments in 2019!
Merit Based Incentive Payment System (MIPS) eligible providers who fail to collect and report a minimum amount of 2017 performance data ...
Evaluation and Management: Correct Coding Crucial for Compliance
2/7/2023
Evaluation and Management: Correct Coding Crucial for Compliance
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/...
Increase in Documentation Submitted Without a Valid Provider Signature Affects Payments
2/7/2023
Increase in Documentation Submitted Without a Valid Provider Signature Affects Payments
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 medic...
2017 Quality Payment Program Hardship Exception Now Available
2/7/2023
2017 Quality Payment Program Hardship Exception Now Available
The Quality Payment Program Hardship Exception Application for the 2017 Merit-Based Incentive Payment System (MIPS) transition year is now available.
Certified electronic health record technology (CEHRT) is required to participate in th...
Prolonged Services Without Face-to-Face Contact Now Separately Payable
2/7/2023
Prolonged Services Without Face-to-Face Contact Now Separately Payable
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 w...
New Prior Authorization Program Effective 10/1/2017 at Fidelis Care
2/7/2023
New Prior Authorization Program Effective 10/1/2017 at Fidelis Care
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 ser...
Important reminder for Physicians who bill Certification and Recertification of Home Health Services to Medicare
2/7/2023
Important reminder for Physicians who bill Certification and Recertification of Home Health Services to Medicare
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 ...
Attention Managed Care Network Providers! New York State now requires all Healthcare providers to enroll with Medicaid.
2/7/2023
Attention Managed Care Network Providers! New York State now requires all Healthcare providers to enroll with Medicaid.
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 ...
The Merit-based Incentive Payment System (MIPS) Updates for 2018 Have Been Released
2/7/2023
The Merit-based Incentive Payment System (MIPS) Updates for 2018 Have Been Released
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 unnec...
Electronic Prescribing Update- New Blanket Waiver for Exceptional Circumstances Approved
2/7/2023
Electronic Prescribing Update - New Blanket Waiver for Exceptional Circumstances Approved 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 wai...