HEALTHCARE NEWS

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...

National Government Services12/28/11  National Government Services will deactivate the telephone line and e-mail box that are currently used for Clinical Education effective July 1, 2011. Providers who direct messages to this e-mail box or phone line on or after July 1 will not receive a r...

Horizon Blue Cross Blue Shield.    Beginning January 1, 2012, physicians, other health care professionals and facilities that participate in the Horizon Managed Care Network may see patients, who are New Jersey residents, enrolled in several new out-of-state national account groups.
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MEDPAGE TODAY - 9/8/2011The CMS is proposing to offer coverage for behavior modification and weight-loss counseling among older, highly obese Medicare patients. The counseling will involve a weekly primary care office visit in the first month, one office visit every other week in the second to sixth...

Adequate and proper medical documentation is essential for quality medical care. We conduct audits to review practitioner documentation and ensure compliance with Centers for Medicare and Medicaid Services (CMS) and New York State Department of Health (NYSDOH) regulatory requirements and to meet Nat...