In this roundup on surprise billing, we offer a big picture view of the issue, with who’s proposing what and who’s not happy about it. Plus, look for lots of links to follow to read up on the details. READ MORE
Anthem Blue Cross and Blue Shield recently announced a new policy of post payment reviews of professional ER claims billed with level 5 E/M codes. The new policy is being implemented to “ensure documentation meets or exceeds the components necessary to support its billing,” according to Anthem, and will begin August 1. Indiana and a few other states currently are excluded. READ MORE
The Indiana Family and Social Services Administration’s (FSSA) new provider enrollment and credentialing solution – FSSA EnCred – will be rolled out in a phased implementation process. Phase one is slated to begin in late summer or early fall 2019. A timeline for additional phases has not been announced. READ MORE
So what exactly is the difference between moderate sedation and monitored anesthesia care? And when does monitored anesthesia care become general anesthesia? READ MORE
Medicare Administrative Contractor WPS-GHA, which serves Part A and B Medicare providers in Jurisdictions 5 and 8, including Indiana, will soon change how they process Not Otherwise Classified procedure codes for Part B claims. READ MORE
A trio of recent studies pulls back the curtain on the growing number of emergency department visits in the United States, revealing how presenting symptoms, geographical location, and insurance coverage (or the lack thereof) influence usage. READ MORE
The number of uninsured adult Americans rose by around 2.8 percent, or about 7 million people, in the last two years, but perhaps more concerning than the uninsured rate is the nagging feeling about half of Americans have that they are underinsured. And for most, it’s more than a feeling. READ MORE
Billing Anthem for anesthesia services administered during labor and delivery requires physicians to follow specialized guidelines, otherwise the claims will likely be denied. READ MORE
Facility-based physicians and other eligible clinicians whose practice takes place primarily in a hospital setting have a new way to meet reporting requirements for MIPS for the 2019 performance year. READ MORE
The Medicare Payment Advisory Commission may soon be recommending national guidelines for coding emergency department visits after the group discussed options for slowing the growth of emergency department spending during their March meeting. The recommendation would task the Department of Health and Human Services with addressing the shift toward high intensity service levels by 2022. READ MORE
