In the December 2004 PRN, Highmark stated that concierge medical practices are “not compatible” with its network requirements. Highmark stated that Blue Cross Blue Shield will initiate termination of impacted provider contracts or a without cause basis upon learning of conversion to concierge practice models.
Medicare & Reimbursement
“Incident To” Rules Effective July 25, 2005
By Michael Cassidy on
Posted in Medicare & Reimbursement
As of Monday, July 25, Medicare will only pay for physical therapy services provided in physician offices “incident to” the physician’s services if the physical therapy services are provided by “qualified personnel” as defined in a June 24 transmittal to Medicare contractors.
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Highmark Defines Concurrent Care Reimbursement Policies
By Michael Cassidy on
Posted in Medicare & Reimbursement
Highmark will pay for care by more than one physician for treatment of hospital or skilled nursing facility in patients when the physicians are treating two or more separate conditions or the severity of the single condition requires the services of two or more physicians. The medical records should:
– Document the primary physician’s request for the consult(s)
– Document the seriousness of the medical condition
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