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Managed Care/Payer Issues
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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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Special Message from NC Medicaid Alert
Special Message from NC Medicaid Alert DMA will implement a number of changes in response to proposed legislated budget reductions. Providers will be notified of operational changes, and coverage and […]
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CIGNA Medical Records Requirements
In response to the protests of organized medicine, CIGNA has determined that it will reduce the mandatory documentation requirements for code combinations with a -25 and -59 modifiers from […]
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Health Plan Provider Contract Bill
Senate Bill 877 has been filed by Senator Clodfelter requiring that contracts between health plans and physicians contain certain provisions. Key provisions of the bill include: (1) requiring contracts to […]
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State Employee Health Plan Bills
The NC General Assembly is considering numerous bills related to the State Employee Health Plan, which covers 660,000+ state employees, teachers and dependents throughout the state. Most of these bills […]
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House Budget Resolution Pave Way for Permanent Medicare Fix
The House version of the FY 2010 Congressional Budget Resolution contains provisions that will facilitate replacement of the fatally flawed Sustainable Growth Rate (SGR) formula with a new incentive based […]
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MEDPAC Minute – State Employee Health Plan Delays Expected
A vote on SB 287 – State Health Plan $/Good Health Initiative (Rand, D-Cumberland) was delayed this week, not once but three times. Heavy opposition by independent retail pharmacies as […]
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