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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...

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…

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…

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…

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...

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.

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…

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 care

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.