Starting January 1, 2019, all Hoosier healthcare providers who hold a controlled substance registration are required to register for Indiana’s INSPECT program and some practitioners are required to check the database before prescribing an opioid or benzodiazepine to a patient. A recent update to the law clarifies the requirements and moves the law from criminal statute to professional licensing statute. READ MORE
CMS recently published the proposed Medicare Physician Fee Schedule for 2020, including several changes that will impact emergency physicians. READ MORE
Managed Health Services will begin post-payment reviews of level 5 emergency department claims for their Hoosier Healthwise, Healthy Indiana Plan (HIP), and Hoosier Care Connect plans in September 2019. READ MORE
As the surprise billing debate continues, emergency physicians have begun lining up behind one bipartisan House bill. READ MORE
Just weeks after Anthem announced then retracted a new post-payment review policy for emergency department level 5 services for its commercial plans in some states, the payer has now announced that the policy will be implemented for Medicare Advantage plans in most states where Anthem conducts business. 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
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
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
A new payment model by the Center for Medicare and Medicaid Innovation (CMMI) hopes to reduce low-acuity hospital visits by allowing ambulance care teams to provide care and transportation based on a patient’s health needs rather than rigid Medicare guidelines. READ MORE
