You May Be Entitled to a Settlement from BCBS
The class action lawsuit, In re: Blue Cross Blue Shield Antitrust Litigation, addresses Provider Plaintiffs’ claim that the Settling Defendants violated antitrust laws by illegally dividing the United States into “Service Areas” and agreeing not to compete in those areas. Provider Plaintiffs also claim that the Settling Defendants fixed prices for services provided. The class action is pending in the United States District Court for the Northern District of Alabama, Southern Division. U.S. District Judge R. David Proctor is overseeing it. Both sides want to avoid the risk and cost of further litigation and have agreed to the Settlement. The Provider Plaintiffs and their attorneys think the Settlement is best for the Settlement Class.
This Settlement Class includes all Providers in the U.S. (except Excluded Providers FAQ 5, who are not part of the Settlement Class) who currently provide or provided healthcare services, equipment or supplies to any patient who was insured by, or was a Member of or a beneficiary of, any plan administered by any Settling Individual Blue Plan from July 24, 2008 to October 4, 2024 (“Settlement Class Period”). Class Members who submit a valid approved claim (“Authorized Claimants”) will receive a payment from the Net Settlement Fund if the Settlement is approved
To visit the official platform Portal for Settlement Class Members to submit claims for a share of the Net Settlement Fund and to get up-to-date information about the Settlement Program. Follow the link below.
Telehealth Breaking News
The below information was received today 12/26/2024, from Betsy Nicoletti
Medicare practitioners and patients can continue to perform/receive telehealth services as they have since the start of the pandemic for the next three months.
The first keep-the-government-open bill from Dec. 20 extended Medicare telehealth for two years. It didn’t pass. The bill that passed and was signed into law extends telehealth for Medicare patients as we know it now until March 31, 2025. Then, Congress must ACT again or we have the return to the pre-pandemic rules
Does this mean we can use the new CPT telehealth codes 98000-98015?
NOT FOR MEDICARE PATIENTS
98000-98015 have a status indicator of INVALID
Continue to use office visit codes with POS 02 or POS 10
And Other Payers?
Sadly, each payer can make their own telehealth rules.
It Is With a Heavy Heart
It is with a heavy heart that POET shares the following:
The man that was instrumental to the foundation and success of POET has passed away.
Ken Smith was more than an advisor and CPA to POET.
He helped physicians and others in more ways than anyone will ever know.
The community as a whole is better because of his involvement.
Kenneth Wayne Smith
August 20, 1936 – December 15, 2024
Funeral services for Kenneth Wayne Smith, 88, of Lufkin will be held Friday, December 20, 2024 at 2:00 p.m. at Lufkin First Church of the Nazarene. Interment will follow in the Garden of Memories Memorial Park. Visitation will be from 1:00 to 2:00 p.m. Friday afternoon prior to the service.
Mr. Smith was born August 20, 1936 in Nacogdoches, Texas, and died Sunday, December 15, 2024 in Lufkin,Texas.
Carroway Funeral Home, Lufkin, directors.
Visitation
Friday, December 20, 2024
1:00 PM – 2:00 PM
Lufkin First Church of the Nazarene
1604 S. Medford Drive
Lufkin, TX 75901i
Funeral Service
Friday, December 20, 2024
2:00 PM
Lufkin First Church of the Nazarene
1604 S. Medford Drive
Lufkin, TX 75901
Aetna OfficeLink Updates 12/1/2024
Claim and Code Review Program (CCRP) Update
Aetna states in their newsletter
“We might have new claim edits for our commercial members.
Beginning March 1, 2025, you may see new claim edits. These are part of our CCRP. These edits support our continuing effort to process claims accurately for our commercial members. You can view these edits on our provider portal on Availity.*
For coding changes, go to Aetna Payer Space > Resources > Expanded Claim Edits
You’ll also have access to our code edit lookup tools. To find out if our new claim edits will apply to your claim, log in to our provider portal on Availity. You’ll need to know your Aetna® provider ID number (PIN) to access our code edit lookup tools.
We may request medical records for certain claims, such as high-dollar claims, implant claims, anesthesia claims, and bundled services claims, to help confirm coding accuracy.”
BCBSTX no longer paying for Consults
Effective 11/18/2024
If you missed it, check out the article posted 9/4/2024
“BCBSTX to Require E/M Codes for Consultation Services”
HHSC Extends Medicaid PEMS Revalidation
~Phil West, TMA
Health and Human Services Commission (HHSC) has provided an extension for physicians due for revalidation between Dec. 13 and May 31 through Texas Medicaid & Health Partnership’s (TMHP’s) Provider Enrollment and Management System (PEMS).
While the extension grants an additional 180 days to physicians due for revalidation between those dates, TMA advises physicians who are due for revalidation over the next six months to file online with HHSC as soon as possible.
2025 Medicare Outlook
1st Come, 1st Served
POET will host MGMA’s 2025 Medicare Outlook Web Event
Date: December 10, 2024
Time: 12 o’clock, noon
Where: POET Office 111 Gaslight Blvd. Ste.B, Lufkin, TX 75949
Lunch will be provided
Limited Seating Available
Call or Email to reserve your place.
Beware these malpractice landmines!
By Logan Lutton, Chris Mazzolini
~Physicians Practice
EHRs are increasingly leading to malpractice lawsuits. While EHR-related lawsuits still make up only a small number of lawsuits, user error is the cause of 64 percent of EHR-related malpractice claims, according to the Doctors Company. Practices need to focus on eliminating several common problems, mostly tied to user actions, which have led to the majority of EHR-related suits
Many doctors are tempted to copy a note from a prior encounter and make changes as appropriate. This leads to a few potential problems.
“Sometimes physicians forget to update the note with the appropriate changes when copying and pasting” David Troxel, MD, MeD & Sec. Doctor’s Company Brd. of Gov.
Drop-down menus can often be the source of a user error that leads to a malpractice suit. Not only can users click the wrong thing in the menu, such as the wrong patient symptom, but these menus lead to structured information that physicians can easily overlook when reviewing a note
Jeffrey Kagan, MD, a Newington, Ct.-based internist, has experience reviewing malpractice cases for attorneys. One trend he has seen related to EHR-induced malpractice suits comes from template use.
“Templates are supposed to help us do something more comprehensive, but often our templates have a lot of old information that carries forward,” he says. In order to avoid falling into this trap, He advises physicians to proofread and modify templates.
The e-prescribing module in an EHR is a potential landmine for malpractice. Alerts indicating when there is a problem with medication dosage or drug-drug interaction will pop up as practitioners are inputting data into the EHR. As a result, doctors get annoyed and develop alert fatigue, and they just turn the alerts off. While this is understandable, turning off the alerts could mean a potential significant problem could go undetected.
Another prompt that goes ignored, often to the determinant of the patient and the doctor, are clinical decision support (CDS) alerts. These are clinically relevant educational materials that come up as the practitioner is documenting in the EHR. Practitioners should ignore these at their own peril, Troxel says. If anything, physicians should document the reason why they overrode the CDS alert.
The idea of physicians missing a vital piece of information in the EHR can be either a user or a technical error. These types of problems are most likely to crop up when a physician is using a new system.
TMA Webinar Helps Equip Physicians for 2025
Medicare Fee Schedule
With the Centers for Medicare & Medicaid Services’ (CMS’) 2025 Medicare Physician Fee Schedule set to take effect Jan. 1, the Texas Medical Association is preparing physicians for changes in payment and coding, telemedicine, and quality and value-based care arrangements, among other areas.
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