Anthem 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.
The 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.
According 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.
On 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.
In 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.
Nothing 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.
The 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.