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

Robert Wood Johnson Foundation has completed “The Synthesis Project,” which is a project summarizing certain research on hospital consolidation over the last decade. Although the report qualifies its conclusion, the Synthesis Project suggests that hospital mergers increase prices, decrease quality and were only anecdotally related to the increase in managed care. The report is available…

ARKANSAS SUPREME COURT RULES ECONOMIC CREDENTIALING POLICIES COULD VIOLATE FRAUD AND ABUSE RULES IN BAPTIST HEALTH CASE

The Arkansas Supreme Court affirmed a state appellate court ruling issuing a temporary injunction prohibiting Baptist Health, enjoining the hospital from enforcing its economic credentialing policies. The basis of this injunction is that the Baptist Health economic credentialing policy, which would prohibit physicians from owning financial interest in competitive facilities from maintaining Medical Staff membership and clinical privileges at Baptist Health, is the following;
Continue Reading ECONOMIC CREDENTIALING POLICIES COULD VIOLATE FRAUD AND ABUSE RULES

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

Physicians had hoped for budget neutrality in the Deficit Reduction Act of 2005, i.e., the “zero update,” expecting the 4.4% decrease implemented by the current Medicare Sustainable Growth Rate rules to be eliminated. The general reimbursement reduction mandated for 2006 was eliminated by DRA 2005, but DRA 2005 requires that the cost of the physician reimbursement increases be offset by future reductions, meaning that DRA 2005 is simply postponing these reimbursement decreases until future years.
Continue Reading Deficit Reduction Act — U.S. House Of Representatives Approves But Medicare Physician Increases Limited

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)

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Tucker Arensberg’s Healthcare Practice Group includes some of the most experienced health law attorneys in the region. We handle the legal problems so our clients can handle the important work of caring for patients. We work with physicians, physical therapists, dentists, optometrists, and all other professional care givers to help them avoid the many legal traps of running a practice. Tucker Arensberg lawyers have experience in all major health law issues.