HEALTHCARE NEWS

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...

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...

Prescribers licensed under Title Eight of the Education Law in New York to treat people, and who have a Drug Enforcement Administration (DEA) registration to prescribe controlled substances—as well as medical residents who prescribe controlled substances under a facility DEA registration numbe...

In January 2017, the Centers for Medicare & Medicaid Services (CMS) approved payment for a new G-code, G0505, which describes assessment and care plan services for patients with cognitive impairment. This code will likely be converted to a permanent CPT code, approved by the CPT Editorial Panel,...

Eligible professionals (EP) who are not meaningful users of certified electronic health record (EHR) technology under the Medicare EHR Incentive Program may be exempt from Medicare penalties if they can show meaningful use would result in a significant hardship.To be considered for an exemption and ...

The New York State Department of Health has determined that many providers are at risk for not being paid for their services because the ordering/prescribing/referring (OPR) provider has not complied with a federal regulation which requires state Medicaid agencies to revalidate enrollment of all pro...

An eligible professional who has never successfully attested to meaningful use under the EHR Incentive Program, and is transitioning to the MIPS in Program Year 2017, may submit this Click here for instructions.  

Medicare covers an Annual Wellness Visit (AWV) providing Personalized Prevention Plan Services (PPPS). Medicare covers the AWV for beneficiaries who are not within the first 12 months of their first Part B coverage period and have not received an Initial Preventive Physical Examination (IPPE) or AWV...

Health insurance was always a major issue in the US. As of January 1, 2014 more than 1million people, that never had insurance before, are now covered by health insurance plans. The Affordable Care Act, also known as Obamacare allows everyone to enroll into a health insurance plan of their choic...

 2013 brings big coding changes for prescribers and non-prescribers alike.  On the psychiatry front, perhaps the most notable change is the elimination of the med-management code 90862.   The 908XX psychiatric code series (90807 and 90817, for example) which covered therapy with ...

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...

 The Office of E-Health Standards and Services (OESS) announced on November 17, 2011, that although the 5010/D.0 compliance date of January 1, 2012 will not change, HIPAA enforcement of compliance with the standards will be deferred until March 31, 2012. The 5010 versions of ...

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...