Medicare is implementing a three year Pre-Claim Review Demonstration of Home Health Services in the states of Illinois, Florida, and Texas beginning in 2016, and in the states of Michigan and Massachusetts beginning in 2017. CMS is testing whether pre-claim review improves methods for the identification, investigation, and prosecution of Medicare fraud occurring among Home Health Agencies (HHAs) providing services to people with Medicare benefits.Read More
The preliminary list of the new ICD-10- CM codes that become effective October 1, 2016 have been released. There are approximately 1600 changes to the code set, making up for the years the ICD-10- CM codes have not had updates.
For FY 2017, many changes have occurred in the ‘O’ Chapter, which consists of codes for the antepartum (first, second, and third trimesters), intrapartum and postpartum (puerperium] - 6 weeks after delivery) periods of a pregnancy.Read More
To help the understanding of what is covered under Dental and what may be covered under Medical, review Regence's coverage criteria:
Coverage under medical or dental benefits is determined by the condition that is being diagnosed and treated, regardless of whether the service is provided by a dentist or a medical doctor.
MEDICAL POLICY CRITERIA
Note: Member contracts for covered services vary. Member contract language takes precedent over medical policy.
I. Dental ServicesRead More
On December 18, 2015, we posted our draft Quality Measure Development Plan, a strategic framework for clinician quality measurement development to support the new Merit-based Incentive Payment System (MIPS) and advanced alternative payment models (APMs). Through March 1, 2016, we asked for stakeholder feedback and received responses from 60 individuals and 150 organizations.Read More
A recent study in the The BMJ (formerly the British Medical Journal)suggests that medical mistakes could be the third leading cause of deaths in the United States. (http://www.bmj.com/content/353/bmj.i2139)
Major news outlets have picked up this story and interviewed various medical professionals:Read More