News & Articles
SENATE TAKES HISTORIC VOTE ON THERAPY CAP REPEAL
April 14th, Senate voted to approve a permanent fix for the sustainable growth rate (SGR) by a vote of 92 to 8. The bill now heads to the President’s desk for signature.As part of consideration of the SGR bill, Senators Cardin (D-MD) and Vitter (R-LA) proposed an amendment to permanently repeal the Medicare therapy caps. Under agreement established by Senate leadership the amendment required 60 votes to pass. Despite obtaining the most votes of any amendment offered this evening, the therapy cap repeal effort failed by a vote of 58 to 42.The overall legislation to repeal and replace the SGR is expected to be signed by the President. Under the bill, the therapy cap exceptions process will continue for 2 years until December 31, 2017.APTA will issue additional information regarding Medicare claims processing along with additional information regarding structural changes planned as the replacement for the SGR. APTA applauds and thanks the thousands of APTA members who weighed in with legislators in support of repealing the Medicare therapy...Looking for meeting topic(s) suggestions
We had a great Annual Meeting that reviewed Billing administration, claims workflow, PQRS and Risk Management. If you missed the event, look in the document section for 2015 Annual Meeting notes and handouts. We also announced that we are looking for topics that you, our members, are interested in having a conference on. Please send your suggestions to either Bob or Berni....Compliance Requirements for Health Care Providers
Humana has recently posted a notice that all providers must complete a Compliance Training, on one of their sites. Please click on: https://www.humana.com/provider/medical-providers/education/whats-new/compliance-requirements to learn where to complete this requirement....Highmark Blue Cross Blue Shield West Virginia (Highmark West Virginia) / Update to liability rejections Effective 4/20/2015
Posted on 02-19-2015 IMPORTANT CHANGES EFFECTIVE APRIL 20, 2015: PROVIDER ASSIGNMENT OF LIABILITYPROVIDER RESPONSIBILITY IDENTIFIED On January 1, 2014 the Committee on Operating Rules for Information Exchange (CORE®) in conjunction with the Blue Cross Blue Shield Association (BCBSA), as part of administrative simplification, mandated (Phase III) Operating Rules for Electronic Funds Transfer & Electronic Remittance Advice (EFT & ERA). Within the Phase III operating rule set is CORE 360 Uniform Use of Claim Adjustment Reason Codes and Remittance Advice Remark Codes (835) Rule, which defines business scenarios and allows code combinations for use on the ERA transaction (835). These business rules identify which party is responsible for non-covered services: providers or members. Highmark Blue Cross Blue Shield West Virginia (Highmark West Virginia) will be implementing this update April 20, 2015. What this means to you is that some previous member liability (rejections) will now become provider liability, as follows:• Maximum number of days authorized have been exceeded.• Authorization was approved for an observation stay only, when inpatient stay occurred.• Required pre-certification/pre-authorization is not on file.This implementation will apply to BlueCard members you are seeing today. In the past, if an authorization was not obtained for a BlueCard (out of area) member, the member was assigned liability and providers could bill the patients.Beginning April 20, 2015, providers will not be able to bill the out of area patients for services rejected for above reasons. Providers should work with their staff submitting authorizations to ensure they are obtaining authorizations for both BlueCard and Highmark West Virginia members.To assist with appropriate authorization requests Highmark West Virginia encourages providers to use NaviNet®. It’s...UHC is requiring all Providers elect their electronic payment method in 2015
UnitedHealthcare-contracted providers, who have not yet enrolled in EPS, must elect their preferred electronic claim
payment method in 2015. Failure to do so, your election will default to Virtual Card Payments – current credit card processing fees will incur!
CAQH has a new look on March 2, 2015
CAQH has incorporated feedback from both provider and health plan focus groups into the development of CAQH ProView. A range of new features will make it easier for healthcare providers to make updates, reducing the time and resources necessary to submit accurate, timely data to organizations that require that information. Providers will be able to easily submit information through a more intuitive, profile-based design