Retail Clinics – will they become the standard?
A recent article published by Medical Group Management Association (MGMA) discusses the growing popularity of retail clinics. Access to primary care physicians can be difficult in times of need even if you are a long established patient. Retail clinics, on the other...
Medicaid Reimbursement Increase for PCP’s
Primary care physicians who care for Medicaid patients could be eligible for higher reimbursement. Under the Affordable Care Act, state Medicaid programs are required to reimburse primary care services at Medicare rates for 2013 and 2014. The payment increase is...
CMS Proposes Higher Incentive to Report Medicare Fraud
On April 24, 2013, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would increase incentives for people to report information that leads to a recovery of funds from individuals and entities that have or are engaged in Medicare fraud...
Bundled Payments Initiative (BPCI)
2013 begins the Bundled Payments for Care Improvement (BPCI) Initiative. The organizations participating in BPCI were announced on January 31, 2013. Under the BPCI, organizations agree to payment arrangements that include financial and performance accountability for...
DEA’s Policy on Locum Tenens
There is often confusion about federal DEA certificate requirements when providers work in multiple states. The DEA's policy states that a provider must have a certificate for "each principal place of business or professional practice". There is an exception for...
Ordering/Referring Providers for Medicare Claims
The Affordable Care Act, Section 6405, requires that physicians who order items or services must be Medicare enrolled providers or Eligible Professionals. The ordering/referring rule was implemented in 2 phases. Phase 1 began October 5, 2009 to alert the billing...
CMS Sequestration Cuts
CMS announces details on implementing sequestration cuts to Medicare claims The Centers for Medicare & Medicaid Services (CMS) released the following message regarding Medicare claims and the upcoming sequestration payment cuts: Mandatory Payment Reductions in the...
GA Medicaid Centralized Credentialing for CMO’s
Georgia Medicaid plans for centralized credentialing for Medicaid CMO's The Department of Community Health (DCH) has announced its plan for implementing centralized credentialing for Medicaid and all three CMO's. Centralized credentialing is targeted to be in effect...
Most Medicare Providers Will Face Performance Penalties
PQRS Payment Penalty Will Become Reality For Most Doctors Most providers participating in the Medicare program are facing reimbursement penalties due to lack of participation in the Physician Quality Reporting System (PQRS). More than 80 percent of participating...
Extension of Medicare Overpayment Recoup Period
President Barack Obama signed the American Taxpayer Relief Act of 2012, often called the “fiscal cliff” agreement, on January 2, 2013. Buried in the 59 pages of the act is a seven-line amendment to Section 1870 of the Social Security Act. This section bars recovery of...
Aetna to sell Missouri Medicaid
Aetna Inc agreed to sell its Missouri Medicaid business to WellCare Health Plans Inc as part of its purchase of Coventry Health Care Inc because their combined Missouri businesses had exceeded Medicaid membership limits. Aetna agreed to acquire Coventry in a $5.7...
Maintenance of Certification (ABMS)
In 2000, the 24 Member Boards of ABMS made significant changes to their recertifiation programs. The ABMS Maintenance of Certification® (MOC) was adopted to require continuous professional development over the career of a physician. The MOC process aims to assure...
