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...

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...

 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 ...

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,&...

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...

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 ...

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...

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...

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...

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 ...