HEALTHCARE NEWS

Starting October 1, 2012, claims for patients who meet or exceed $3,700 in therapy expenditures will be subject to a manual medical review. For outpatient therapy services that exceed $3700 there will be an advanced approval process that will be implemented in three distinct phases. Providers will b...

INTERNET - 9/8/2011National Government Services, Inc. is currently conducting a service-specific prepayment review for Physical Therapy and Occupational Therapy Services being performed by specialties other than Specialty 65 (Physical Therapist billing independent) and 67 (Occupational Therapist bil...

Horizon Blue Cross Blue Shield. January 24, 2012 In 2012, Horizon Blue Cross Blue Shield of New Jersey will require the use of Electronic Funds Transfer (EFT). In the first quarter of 2012, we will begin to require the use of EFT for newly credentialed group practices and solo physicians and oth...

The Centers for Medicare & Medicaid Services (CMS) is implementing an immediate recoupment process for demanded overpayments. As it stands, Medicare contractors begin recoupment of an overpayment on day 41 from the date of the initial demand letter. Effective July 1, 2012, however, providers can...

HEALTHDAY NEWS - 9/8/2011A report from the CDC says that about 25% of Americans experienced mental illness in the past year, and experts project that about half will suffer a form of mental illness in their lifetime. The cost of mental illness, including treatment and lost productivity, was roughly ...

In response to yesterday's release of the White House budget proposal, provider groups are quickly blasting the President's proposed $320 billion cuts to Medicare and Medicaid, fearing repercussions for hospitals and their patients. First announced in September, the federal plan targets $3.8 tri...

As part of President Obama’s commitment to reducing regulatory burden, Health and Human Services Secretary Kathleen G. Sebelius today announced that HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseas...

The Temporary Payroll Tax Cut Continuation Act of 2011 (H.R. 3765) signed by President Obama on December 23, 2011, provides for a 60-day delay in the 27.4% cut in Medicare physician reimbursement scheduled to take effect on January 1, 2012. Despite the “delay”, your fee schedule wil...

Blue Shield of California is paying $2 million to settle allegations that it improperly stopped covering members when they became sick and required expensive treatment. The insurer decided to settle a 2008 suit, in which the Los Angeles City Attorney's Office alleged Blue Shield's recession prac...

INTERNET - 9/8/2011In accordance with the Centers for Medicare & Medicaid Services (CMS) directive to include information and opinions from members of the general public as part of the local coverage determination (LCD) process, National Government Services will host open, public meetings at whi...

National Government Services 01/04/12Suppliers of the technical component of Advanced Diagnostic Imaging that are billing with a service date on or after Sunday, January 1, 2012, must evidence an active accreditation date for diagnostic imaging of current procedural terminology (CPT) codes attached ...

Effective for claims processed with dates of service on or after Jan. 1, 2011, Outpatient Prospective Payment System (OPPS) providers should report HCPCS Level II code G0010 Administration of hepatitis b vaccine for the administration of hepatitis b vaccine, rather than CPT® 90471 Immunization ...

Horizon Blue Cross Blue Shield. January 1, 2012 Effective January 1, 2012, Horizon Healthcare of New Jersey, Inc. will offer a Special Needs Plan (SNP), Horizon Medicare Blue Total Care (HMO SNP), to New Jersey residents who are eligible for both Medicare and Medicaid coverage. This $0 p...

Aetna    Aetna buys popular mobile app iTriage maker for ACO, which provides information about medical issues and finds nearby providers or health facilities. "We're going to begin to change the healthcare industry by giving people tools they can put in the palm of their hand,&...

Congress passed a bill to delay a scheduled 27% cut in Medicare payments by 10 months, and the president released his 2013 proposed budget, which requests a slight increase for health programs. Congress Passes SGR Deal The House of Representatives voted 293-132 late Friday morning to pass a ...