We are less than six months away from a major shift in the way consumers and small-business owners shop for healthcare insurance. On October 1, 2013, enrollment begins for the state insurance exchanges, as prescribed in the Patient Protection and Affordable Care Act. While the goal of the exchanges is to allow the currently insured and uninsured to have access to a competitive marketplace for shopping for coverage – there ...

Because the President and Congress were not able to reach an agreement to avoid the sequester, across-the-board budget cuts will go into effect March 1, 2013. The sequester includes a 2% reduction in the Medicare Physician Fee Schedule. Physicians will catch a slight break because, by law, mandatory cuts to Part A and B of Medicare cannot be implemented less than 30 days from the date the order is issued. ...

By now, most of us are familiar with the eRX incentive payments and penalties for those practitioners that are not actively e-prescribing. And, though we have all heard a lot of buzz about PQRS – maybe you or your staff need a little more information to fully understand the implications of the Physician Quality Reporting System. The PQRS system uses a combination of incentive payments and penalties (payment adjustments) to ...

Vaccination Changes – Effective January 1, 2013 Influenza New Codes: · 90653-Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use · 90672-Influenza virus vaccine, quadrivalent, live, for intranasal use · 90685-Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use · 90686-Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to individuals 3 years of age and older, for intramuscular use ...

We all received some good news in the early hours of 2013. On January 1, 2013, Congress approved legislation that prevents the scheduled SGR and sequestration cuts to the Medicare fee schedule. The 26.5% SGR cut has been delayed until early March, when the legislation will be reviewed again. Congress approved a one-year freeze in the Medicare conversion factor, and has extended several Medicare Provider Payment provisions, while also implementing ...

On December 19, 2012, CMS distributed the following message to healthcare providers accepting Medicare: Attention Health Professionals: Information Regarding the 2013 Medicare Physician Fee Schedule The negative update of 27% under current law for the 2013 Medicare Physician Fee Schedule is scheduled to take effect on January 1, 2013. Medicare Physician Fee Schedule claims for services rendered on or before December 31, 2012, are unaffected by the 2013 payment cut ...

The Affordable Care Act (ACA) requires each state to have a health insurance exchange through which low and moderate-income individuals can purchase private health coverage at subsidized rates. In line with the mandate that each individual have health insurance by 2014, the exchanges are likewise required to be fully operational in each state by January 1, 2014. (Open enrollment for the exchanges begins October 1, 2013.) The ACA allows each ...

Earlier this year, the Department of Health and Human Services announced its proposed rule to implement the Affordable Care Act provision that Medicaid reimburse primary care providers at the same rate as Medicare. On November 1, 2012, CMS issued a final rule to implement this increased payment for calendar years 2013 and 2014. Effective January 1st 2013, eligible primary care providers will be paid at rates established by the Medicare ...

The news that so many local healthcare providers and Maryland medical billing companies have long awaited: Carefirst now allows for the electronic submission of Medicare secondary claims! This is a huge time and money saver when handling those secondary claims that did not automatically crossover from Medicare to Carefirst. This change actually became effective back in July 2012, was announced in September, and clearinghouses have since been setting up their ...