PROGRAM (CAP)
FOR PART B DRUGS ENROLLMENT DEADLINE IS JUNE 2, 2006
This is just a reminder that the Competitive Acquisition Program for Part B drugs for Medicare physicians will be open for enrollment only until June 2, 2006. Participating physicians will be given the opportunity to obtain and bill for Medicare Part B covered…
FOR CARDIAC REHABILITATION PROGRAMS
Effective for services performed on or after March 22, 2006, the Centers for Medicare and Medicaid Services (CMS) is updating Section 20.10 of the Medicare National Coverage Determinations Manual (NCD Manual) to include additional clinical indications for which cardiac rehabilitation services are covered. The NCD Manual now includes a comprehensive description…
CMS PUBLISHES FINAL ENROLLMENT REQUIREMENTS FOR MEDICARE PARTICIPATION
The Centers for Medicare and Medicaid Services (CMS) have published the final rule establishing the enrollment requirements for participation in Medicare. The proposed rule was published on April 25, 2003. There are no significant surprises in the final rule, which does the following:
Continue Reading CMS PUBLISHES FINAL ENROLLMENT REQUIREMENTS
The Medicare Modernization Act of 2003 required the Secretary of Health and Human Services to make the national coverage determination (NCD) process a public and transparent process, with the intent of making the NCD process one that would be better serve Medicare providers and beneficiaries. On April 11, 2006, CMS issued two documents related to “Guidance for The Public, Industry and CMS Staff,” i.e.:
Continue Reading National Coverage Determination Process – CMS Issues Final Guidance Documents
The Highmark Blue Shield Prior Authorization requirement for enumerated diagnostic imaging procedures will become effective April 1, 2006. The Prior Authorization Guide (Guide) is available on the Highmark Provider Resource Center Web site.
Continue Reading Highmark Prior Authorization Requirement For Diagnostic Imaging: April 1, 2006
HIPAA requires all healthcare providers to use the National Provider Identifier (NPI) for electronic transactions as of May 23, 2007. Providers can obtain and use NPI now according to the following timetable:
Continue Reading NATIONAL PROVIDER IDENTIFIER (NPI)
The Blue Cross Association posted some reactions from organized medicine to the recent agrement by the AMA to develop performance measures. See http://bcbshealthissues.com.
The American Medical Association has signed pact with Congress “agreeing” as follows:
*The parties will develop a total of 140 quality measures covering 34 clinical areas.
*Doctors will voluntarily report on at least 3 to 5 quality measures per physician by 2007.
*Doctors should receive additional reimbursement to cover administrative costs.
Continue Reading AMA AND CONGRESS SIGN P4P AGREEMENT
DEFICIT REDUCTION ACT OF 2005:
SUMMARY OF MEDICARE REIMBURSEMENT CHANGES
President Bush signed the Deficit Reduction Act of 2005 (DRA 2005) on February 8, 2006. DRA 2005 contained numerous budget cutting provisions impacting Medicare and Medicaid reimbursement programs. Following is a description of the most significant.
Continue Reading DEFICIT REDUCTION ACT OF 2005:
AMBULATORY SURGERY CENTER, GAIN SHARING DEMONSTRATION PROJECTS, THERAPY SERVICE, AND SPECIALTY HOSPITAL REFERRAL PROHIBITIONS
As reported last week, the House of Representatives has passed the Deficit Reduction Act of 2005 (DRA 2005), which is expected to be signed by President Bush in the very near future. When ultimately passed, we will provide a more detailed explanation of the critical issues, but the following are additional reimbursement issues impacted by DRA 2005:
Continue Reading MORE DRA 2005 REIMBURSEMENT NEWS
