Latest News

2019 Year End

2019 Year End

by Lori Gutierrez – Vice President It’s hard to believe another year is coming to an end, but here we are. There is a saying, the older you get the faster it goes. Some liken it to a roll of toilet paper, the closer you get to the end the faster the roll goes ☺ I...

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Coding Alert – Diagnosis Descriptions

Coding Alert – Diagnosis Descriptions

by Nicoleta Rahovan Lead Coder CPC CANPC It's October and as coders, we know this is the month when the ICD-10-CM for 2020 diagnosis codes are being implemented.  Starting with October 1st DOS we need to make sure we correctly incorporate the updated 2020 ICD-10-CM...

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Reminders

Reminders

Anthem Effective October 1, 2019, Blue Cross will require providers to submit their charges within 90 days from the date of service.  It is imperative that RCM get these cases as soon as possible to verify coverage and submit the claim within the 90 day window to...

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Prepayment Clinical Validation Review Process

Prepayment Clinical Validation Review Process

Effective with dates of service on or after September 5, 2019, multiple Anthem plans announced they will initiate a prepayment clinical validation review process for claims with a number of modifiers, including 25 (Significant, separately identifiable...

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Problems Affecting Easy Billing

Problems Affecting Easy Billing

Several changes over the past few years have made the act of collecting what was once considered “easy billing” significantly more challenging: AB72 rules GI reimbursement policies Surge of Medi-Cal members into PPO plans and HMO relationships Enrollment requirements...

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Anthem Timely Filing

Anthem Timely Filing

NEW TIMELY FILING LIMIT FOR ANTHEM BLUE CROSS PROVIDERS Do you typically submit your cases for billing 60+ days following the date of service? You could be headed for hard times! Effective 10/1/2019, all claims must be received by Anthem no later than 90 days...

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The 2017 QPP REPORTING RESULTS ARE IN

The 2017 QPP REPORTING RESULTS ARE IN

We are pleased to announce that RCM’s QPP submissions were successful and all of the providers that we submitted 2017 QPP measures to CMS via our Registry will receive either a small upward payment adjustment or have achieved a neutral score. This score will be...

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Blue Cross Requires Authorization for MAC GI Cases

Blue Cross Requires Authorization for MAC GI Cases

Effective with dates of service January 1, 2019 Blue Cross is requiring a Prior Authorization for MAC Gastrointestinal Endoscopic Procedures. View Here It is extremely important that anesthesiologists either receive a copy of the authorization indicating their...

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2019 Physician Fee Schedule and Updates

2019 Physician Fee Schedule and Updates

By Beth Turnbaugh, Director of Operations, November 13, 2018 CMS has released the 2019 Physician Fee Schedule, 2019 MIPS Quality Measure reporting and some other items that may impact your practice. Please read below. Physician Conversion Factor Physician conversion...

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Contracting – What You Don’t Know, Can Hurt You

Contracting – What You Don’t Know, Can Hurt You

Health Plan and Managed Care agreements can make or break an anesthesia practice, depending on the utilization and membership ratios. Many anesthesiology providers are presented with third party payer agreements that include less than favorable reimbursement, unfair...

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New Guidelines for Colorectal Cancer Screening

New Guidelines for Colorectal Cancer Screening

In May the American Cancer Society lowered the age for people at average risk* to start regular colon cancer screening at age 45 due to a steep increase of colon cancer patients under 50. This can be done either with a sensitive test that looks for signs of cancer in a…

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