HEALTHCARE NEWS

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...

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 ...

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...

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 ...

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...

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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Kaiser Permanente    Kaiser Permanente of Colorado hopes a new incentive--cold, hard cash--will motivate people to lose weight. Although other insurers have offered similar programs, Kaiser is one of the first to make a weight loss program available to all adult members, the Associated...

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...