BCBSAnthem BCBS of Connecticut, Indiana, Ohio, New Hampshire and Empire BCBS of New York are working with OrthoNet, LLC to process precertification requests and conduct post service prepayment coding reviews of professional services for their Medicare Advantage members. This program began on January 1, 2015 and is for professional claims only. Facility claims are excluded.

modifier59Many private payors have announced they will use the new 59 (Distinct Procedural Service) modifier subsets released by CMS this past summer. The four modifiers, collectively know as the  X(EPSU) modifiers, will be effective for most carriers on January 1, 2015.

compliance So now you have done the hard work of obtaining, evaluating and negotiating the contracts with your payors, it is now an important part of your day-to-day revenue cycle processes to ensure that they are honoring the terms of these contracts.

CMSThe Centers for Medicare & Medicaid Services (CMS) is pursuing additional rule-making potentially leading to reduced meaningful use requirements in 2015, one of which is a 90-day rather than a full-year reporting period, according to the federal agency’s blog.

Doctor with PatientAccording to Medscape's Physician Lifestyle Report, physicians are burned out and only getting more so.  And the most important cause of burnout - bureaucracy and spending too much time at work on administrative tasks.

manvslamppost Click to view Infographic.


CMSOn January 13, 2015, CMS conducted a call providing further details on the electronic submission options available for the 2014 PQRS program. Presentation materials from this call are available on the CMS website.

HHSIn a meeting with nearly two dozen leaders representing consumers, insurers, providers, and business leaders, Health and Human Services Secretary Sylvia M. Burwell today announced measurable goals and a timeline to move the Medicare program, and the healthcare system at large, toward paying providers based on the quality, rather than the quantity of care they give patients.

negotiatingNothing is more important in any negotiation than preparation, preparation, preparation. It is no coincidence that the party that is better prepared for a negotiation is much more likely to walk out with the best outcome. Preparation includes understanding the standing, the perspective and the goals of the payor as well as that of your physician practice.

congressThe Medicare Sustainable Growth (SGR) formula was enacted by Congress as part of the Balanced Budget Act of 1997. The intent of the formula was to control the growth of Medicare spending for physician services by tying Medicare payment for services to physicians to the overall status of the economy. Basically, if the U.S.