Archive for September, 2009

  • Medical Board Profiling – An Update

    The NC General Assembly enacted legislation disapproving specific elements of the NCMB’s rules on malpractice profiles. As you will see, the disapproved rule provisions are replaced by statutory provisions contained […]

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  • Medicaid Provider Rate Cut Being Implemented Oct.1

    NC Medicaid has announced their proposed State Plan Amendments to save over $200 million from medical services and goods over the next two years. In order to achieve $76 million of this savings this year, NC Medicaid will make a 9% cut to all but 89 specific codes used by physicians and other providers caring for Medicaid patients.

    The Medicaid codes that have been protected will continue to be paid at 95% of Medicare. The other codes will be slashed to an average of 86.5% of Medicare rates. Hospitals that are not owned by the State of North Carolina will also be impacted with a 6% cut to their DRG.

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  • Bulletin for 9/25/2009

    Bulletin for 9/25/2009

    Volume 60 Issue 44 Featured Stories Medicaid Rate Adjustments Debated The Department for Health and Human Services (DHHS) is moving quickly to make changes to achieve the $76 million in […]

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  • Medicaid Rate Adjustments Debated

    The Department for Health and Human Services (DHHS) is moving quickly to make changes to achieve the $76 million in provider rate savings mandated by the NC General Assembly this year. A number of proposals for how to achieve that target are still being discussed. DHHS is considering multiple proposals that would make adjustments based on a physician’s specialty and other proposals that would that would create variable cuts to individual reimbursement codes. Both of these solutions would cause massive divisions within the physician community that could threaten the stability of NC Medicaid.

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  • Compliance Dispute Officer Issues Ruling in Oncology/Rheumatology Dispute

    In a disappointing ruling, Compliance Dispute Officer Martin Quinn has determined that the pricing policy and associated actions taken by Blue Cross Blue Shield of North Carolina did not violate key provisions in the BCBS Settlement Agreement.

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  • Temporary Order Requires NC Physicians to Report Influenza-Related Deaths of Persons 18 and Older

    The State Health Director has issued a temporary order requiring North Carolina physicians to report all influenza-associated deaths in persons 18 years of age or older. Influenza deaths in children less than 18 years of age have been legally reportable since 2004. This order is necessary to enhance influenza surveillance during the current pandemic.

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  • Aetna Agrees to Pay Two E&M Services on the Same Day

    After much discussion with physician advocacy groups, Aetna has determined that it will pay two E&M Codes on the same day, using the 100/50 “concurrency rule.”  The preventive medicine visit will […]

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  • CDC Posts FAQ for Physicians Concerning H1N1 Flu Virus

    The CDC has posted H1N1 Clinicians Questions and Answers covering a variety of questions physicians have asked concerning the H1N1 flu vaccine. Several physicians have contacted the NCMS asking for […]

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  • AMA Reaches Out to Sen. Baucus Regarding “America’s Healthy Future Act of 2009”

    American Medical Association Executive Vice President/CEO Michael D. Maves, MD, MBA, recently sent a letter to Senate Finance Committee Chair Max Baucus regarding the recently released Baucus plan for health […]

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  • Conflicting Data Over Influenza Trends in North Carolina

     State Influenza Surveillance Coordinator Terry McLean says that the latest information on influenza cases from sentinel sites and hospital emergency rooms differs.  Data from the Sentinel Provider Network (SPN) indicate […]

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