Managed Care/Payer Issues

  • Medicaid Radiology Preauthorization Orientation

    Please be aware that Medsolutions, the vendor for the new Medicaid radiology preauthorization program, will hold numerous on-line orientation sessions from October 7-November 4, 2009.

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  • CIGNA Medicare Publishes Checklist for Signatures

    In response to questions by NCMS, CIGNA Government Services has created a checklist outlining requirements for physician signatures on claims and other forms of documentation.

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  • Medicaid Provider Rate Cut Implemented Oct. 1

    Comments from physicians have poured in to the NCMS following the NC Medicaid announcement on Tuesday that it would make a 9% cut to all but 89 specific codes used by physicians and other providers caring for Medicaid patients. NCMS and other physician groups have met with numerous state officials and offered complete accessibility to physicians for a dialogue about the proposed cuts. This level of cut to the provider rate services was not discussed in advance.

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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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  • 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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  • 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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  • Primary care Provider contract by major insurers, like BCBS, MedCost, Cigna, Aetna etc…

    Why all these insurers wants to pay us less and less for services but wants more of our services in return? There is no way a Primary care practice can survive […]

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  • CMS Documents Cover ASCs, EMTALA, Infection Control and Use of EHRs

    The Centers for Medicare and Medicaid Services has issued several important documents of interest to physicians concerning ambulatory surgical centers, EMTALA requirements and options during a disaster, infection control compliance […]

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  • BCBSNC Joint Advisory Group Compiles List of Issues

    The Joint Advisory Group or “JAG” was formed as a result of the lawsuit settlement agreement between BCBSNC and North Carolina physicians to discuss issues arising from or related to […]

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