Latest News

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 E/M service on...

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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

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

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

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

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

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

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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New Medicare Numbers and Cards

In May Medicare started sending Medicare recipients their new Medicare cards. The new unique Medicare number or Medicare Beneficiary Identifier (MBI) will replace the current Health Insurance Claim Number (HICN) – patient’s social security number (SSN). All social…

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California Legislation

Last week, there was legislation introduced in California that has the potential to radically reduce both patient care and access, increase out-of-pocket costs, and seriously affect medical care throughout the state. Here are the facts of the bill: This bill could lead…

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2018 GI Changes

2018 GI Changes To receive maximum reimbursement in 2018 for GI cases, it is imperative that you provide as much documentation as possible. Originally CMS and the AMA were following the guidelines outlined below. A colonoscopy that starts as a screening colonoscopy no...

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