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Managed Care/Payer Issues
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NCMS and PAI Release Documentary Warning Practices About Consequences of Medicare Audits
Yesterday the NCMS and the Physicians Advocacy Institute, Inc., (PAI) released a documentary detailing the two-year ordeal that Eastern Carolina Internal Medicine (ECIM) experienced during a Medicare audit.
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CIGNA Announces 90-Day Claim Submission Requirement
CIGNA Health Care of North Carolina recently mailed a notice to providers stating that as of August 1, 2012, the timeframe to submit claims for reimbursement will change to 90 […]
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Assessment of Audit Contractors Reveals Failure to Identify Overpayments
The Office of Inspector General of the U.S. Department of Health and Human Services (DHHS) released a report entitled “Early Assessment of Audit of Medicaid Integrity Contractors,” which found that 81% of the Centers for Medicare & Medicaid Services’ (CMS) pre-screened audits undertaken to fight waste, fraud and abuse in Medicaid were either unable or unlikely to identify overpayments during a recent six-month period.
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CMS Reopens 2013 eRx Hardship Exemption Request Period
If you are a provider who needs to file for hardship exemption for the 2013 Electronic Prescribing (eRx) payment adjustment, your opportunity to do so has been extended. The Centers […]
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Update on Medicaid’s Move to Require Direct Enrollment of PAs
In the March Medicaid Bulletin issued this week, DMA again announced that physician assistants are eligible to enroll directly as Medicaid providers. The article confusingly states that PAs “may be enrolled effective April 1.” It is not clear if April is the new deadline that DMA has set for the submission of enrollment applications.
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BCBSNC Pursues Appeal of DOI Decision on Multiple Radiology Reduction Policy
BCBSNC has appealed the DOI’s decision to an administrative hearing officer. Quickly after BCBSNC filed its appeal, the NCMS, NCHA, and NCRS requested to intervene in the case and were granted full-party status by the Hearing Officer. As full parties, the three organizations will help the DOI defend its position that BCBSNC must follow the fair contracting statutes before implementing the radiology policy.
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NC Consumers and Businesses Sue BCBSNC, Allege Anticompetitive Behavior in State Insurance Markets
Groups of individuals and businesses that hold health insurance policies with Blue Cross and Blue Shield of North Carolina have filed a class action lawsuit in federal court against both BCBSNC and the Blue Cross Blue Shield Association. The complaint highlights BCBSNC’s dominance in state health insurance markets and alleges violations of federal antitrust laws and unlawful restraint of trade under state law.
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TIP Sheet Offers Help for Handling Physician Ratings by Health Plans
Worried about physician ratings and tiering by health plans? The Physicians Advocacy Institute (PAI) has created the TIP Sheet for Physicians: Reviewing and Disputing Physician Rating and Tiering by Health […]
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Court Approves Payments to Physicians in Class-Action Lawsuit Against UnitedHealth
Physicians will soon receive long-awaited payments resulting from a hard-fought legal battle against this major health insurance company.
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BCBSNC Switching to New Pharmacy Benefits Manager
As of April 1, 2012, Blue Cross and Blue Shield of North Carolina will have a new pharmacy benefits manager (PBM), Prime Therapeutics. The insurer advises physicians and patients that it […]
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