January 2006

On December 23, 2005, CMS implemented a streamlined PVRP by reducing the number of quality indicators to be reported using G-Code indicators from the original 36 to a “core set” of 16 special quality indicators. The revision was described in a new MedLearn Matters Release (MM 4183) and was implemented as of January 3, 2006.
Continue Reading CMS Revises Physician Voluntary Reporting Program (PVRP)

Credentialing Developments: U.S. Supreme Court Refuses To Review Hearing Officer Authority Ruling; Ohio Court Of Appeals Allows Discovery Of Peer Review Records Under Prior Law

Hearing Officer Authority

In California, a Medical Staff Hearing Officer terminated a Medical Staff Hearing on the grounds the physician was “repeatedly disruptive, disdainful of the Hearing Officer’s authority, and flagrantly violated the rules pertaining to discovery and documentary exhibits.” This ruling allows the ruling by a California State Court that the termination did not violate the physician’s due process rights to stand. Meleikowsky v. Tenet Healthsystem, U.S. No. 05-638.
Continue Reading Credentialing Developments

AUTOMATIC 4.4% MEDICARE REDUCTION EFFECTIVE JANUARY 1, 2006; CMS ADVISES DELAYED SUBMISSION TO EXPEDITE PLANNED “ZERO UPDATE”

CMS officials suggested that physicians intentionally delay submitting claims to await passage of the “zero update” feature of the proposed Deficit Reduction Act of 2005.
Continue Reading AUTOMATIC 4.4% MEDICARE REDUCTION EFFECTIVE JANUARY 1, 2006

The Commonwealth Court of Pennsylvania ruled on December 29, 2005 that a group of policyholders, subscribers, public interest groups and the City of Philadelphia did not have standing to challenge the Pennsylvania Insurance Department’s approval of reserves and surpluses for the State’s Blues plans, i.e., Capital Blue Cross, Highmark, Blue Cross of Northeastern Pennsylvania and Independence Blue Cross.
Continue Reading Pennsylvania “Blues” Win Challenge Regarding Allowable Reserves

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