At the outset. we must correct two misunderstandings about the Guideline. First, the guideline, while published on December 27. 2017 and then revised and re-published on February 1, 2018, has not been implemented and is not yet in effect for our California membership.read more
We are now entering year two of QPP reporting and there are some changes. Since 2017 was considered a “Transition Year”, CMS reduced the reporting requirements to help transition EP’s (eligible professional) into the new QPP program. 2018 reporting requirements will be more comprehensive, and the biggest change for qualified…read more
California Clients Anthem MAC Anesthesia for Cataract Cases. We have recently received news that Anthem has changed their policy in regard to the Medical Necessity of MAC anesthesia for cataract cases. Anthem states “Administration of moderate sedation, monitored anesthesia careread more
Effective July 1, 2017, non-contracted providers providing services at a contracted/in-network facility
may not balance bill an out-of- network patient (OON) for their full fee.