I Am Going to File A Complaint!!!!
Now you do! POET has scoured the Universe. We have compiled information on how to file a complaint, with just about anybody you might want to file a compliant with. The OIG, TDI, BBB, CMS, TRS, ERS, Texas School Board, State Employees, Federal Employees, CHIPS, Self Funded Employee Groups, TMHP, Tricare, the Attorney General… Check it out, downloaded it, get out your pen….
MGMA 2021 Medicare Outlook
MGMA hosted their “2021 Medicare Update” yesterday Dec. 10th. That presentation has been recorded and is available for MGMA members on their website.
For your convenience the slide deck has been place in POET InK’s files. To view follow this path.
Aetna OfficeLink Updates Published 12/1/2020
For new and updated information on:
- Changes to Aetna’s National Precertification List (NPL)
- Surgical procedures performed in the ER, modifier 54, rate change
- Beginning March 1, 2021 you may see new claim edits. These will be part of Aetna’s 3rd Party Claim and Code Review Program.
- Individual Service Codes are being assigned to Service Groups (a lot of changes are coming)
- Changes in Commercial and Medicare Drug list
- Changes in Prior Authorization Requirements
TMA’s Reimbursement Specialist Want You to Know
About These Items That Are Listed in the UnitedHealthCare December Bulletin:
- Starting January 1, UHC will follow the revised 2021 E&M coding and guideline changes for the AMA and CMS.
- January 1, for Medicare Advantage plans, UHC will expand prior authorization requirements and site-of-service medical necessity reviews.
- And, UHC has delayed implementation of its Laboratory Test Registry protocol
HSConnect provider portal/MHK FAQ 11/23/20
As you are likely aware, the HSConnect provider portal underwent an MHK integration on 10/30/2020. The MHK implementation team created an FAQ to reflect some recent questions and answers that a provider staff member may have. The updated provider portal document is available here on Ink, Just a click away.
New coding guidelines a recipe for improved revenue 11/20/2020
Bill Dacey, MHA, MBA, CPC-I is principal in The Dacey Group, Inc., a consulting firm dedicated to coding, documentation and compliance concerns for physicians.
36 Guidelines to Evaluate a Practice Management
Need to know where to begin:
- Financial Management – Billing and Collections
- Financial Management – General
- Personnel Management
- Marketing and Practice Promotion
- Self Development
- Leadership Skills
Clash of the Titans? CHI vs BCBSTX
BCBSTX and CHI (CommonSpirit) are clashing over their contract.
CHI has given termination notice to BCBSTX. The termination is effective after December 16, 2020 according to a letter received from BCBSTX.
This termination will affect physicians with privileges ONLY at CHI hospital and not with another in network facility. This is because physicians are required to have privileges with an in network facility.
If you also are “on staff” at Woodland Heights or another in network facility this does not affect your credentialing with BCBSTX.
Physicians may reach out for privileges with other in network facilities OR Physicians may have arrangements for care of their patients at other in network facilities if necessary.
POET has not mentioned this before because most of the time these situations are resolved at the last minute. We believe both parties need each other and therefore will find a solution.
We have had a few calls asking what physicians can do. Since BCBSTX has state employees, we suggested reaching out to your legislators. It seems unfair for patients and physicians to be caught in the middle of the clash of the titans.
Just when you thought you could believe 11/13/20
According to United HealthCare there will no longer be a Provider Advocate, as in the past. Please follow the links from the previous post (UHC New Service Model for Claim Reconsideration, July 9, 2020) for information on UHC’s new service model, how to check eligibility and benefits, referrals, Auths and claim reconsideration, etc.. Click here to review email from UHC.
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