United Health to Replace TriWest as of April 1, 2013
Friday, March 16, 2012 Today TriWest Healthcare Alliance learned it was not awarded the contract to continue to manage the 21-state TRICARE West Region for the Department of Defense (DoD). This announcement comes after TriWest secured the contract in July 2009. “We are extremely disappointed that the Department of Defense chose to reverse their decision. [...]
5010 Compliance Extended
Today, March 15, 2012 CMS’ Office of E-Health Standards and Services (OESS) is announcing that it will not initiate enforcement action for an additional three (3) months, through June 30, 2012, against any covered entity that is required to comply with the updated transactions standards adopted under the Health Insurance Portability and Accountability Act of [...]
New Insurance Secondary to Medicare…
Do you know if the new Secondary carrier updated Medicare’s database with the patient’s policy information? Medicare relies on the secondary insurance company to self report a new enrollee. If the secondary company does not report their new enrollee it delays payments and creates a costly manual process. Your office staff can, on a one [...]
Congress Passes Measure Avoiding Medicare Payment Cut and Therapy Cap Exceptions Expiration
Today, the U.S. House of Representatives and the U.S. Senate passed a 10-month measure that will prevent a 27.4% payment cut, due to the flawed Sustainable Growth Rate (SGR) portion of the fee schedule, to Medicare providers scheduled for March 1. The measure extends the Geographic Practice Cost Index (GPCI) at the current level, and [...]
Health Insurance Deductibles
January 1, 2012 means deductibles start over again for many health insurance policies including Medicare. The 2012 Medicare Part B deductible will be $140.00. Medicare Part B beneficiaries who do not have a supplemental plan may be responsible for 20% of the Medicare approved amount for services after meeting their deductible.
Aetna Network for Behavioral Health now Open
Aetna’s Behavioral Health network is now open in Colorado’s Larimer and Weld counties. To become a provider with Aetna go to Aetna’s Provider Enrollment page (click this link) and complete the Application Request.
2012 Payment Rate Changes Announced by Medicare
More than 1 million providers of health services to Medicare patients are paid under the Medicare Physcian Fee Schedule (MPFS). Without intervention from Congress the MPFS will experience a 27.4% reduction in 2012. Under current law, providers will face steep across-the-board reductions in payment rates, based on a formula– the Sustainable Growth Rate (SGR) – [...]
November 1, 2011 is the Deadline
Providers have only ten days remaining to request a hardship exemption for the 2012 electronic prescribing (eRx) payment adjustment. Eligible professionals (EPs) who have not met eRx Incentive Program requirements (and who are not exempt) will incur a 1 percent payment reduction to their allowable Medicare Part B charges beginning Jan. 1, 2012. To determine if [...]
Did you know….
under the Affordable Care Act of 2010 all Medicare payments must be electronic by January 1, 2014. If you’re not currently receiving EFT payments from Medicare you’ll be required to complete and submit the CMS 588 EFT form to start receiving them. accepting EFT payments from health insurers can save you thousands of dollars annually [...]
Insurance Overpayments – What should you do…
You’ve just learned that one of the insurance carriers overpaid a claim – what should you do? The law is specific on how these funds should be handled. The Fraud Enforcement and Recovery Act (FERA) which passed in 2009 clearly states that any person who knowingly conceals or knowingly and improperly avoids an “obligation to [...]
