Fees

• Pharmacy (POS code 01);
• School (POS code 03);
• Homeless Shelter (POS code 04);

Anthems original plan was to take a 50% reduction when providers reported claims using modifier 25, it was then lowered to a 25% reduction and has now been fully rescinded, to the relief of providers.  The policy was to go into effect March 1, 2018, however, due to strong opposition from the American Medical Association and other groups Anthem decided it was not in the best interest between payers and providers. 

Continuing the commitment to greater data transparency, the Centers for Medicare & Medicare Services (CMS) today released privacy-protected data on the prescription drugs that were paid for under the Medicare Part D Prescription Drug Program in 2014. This is the second release of the data on an annual basis, which shows which prescription drugs were prescribed to Medicare Part D enrollees by physicians and other healthcare professionals.

On Feb, 12, 2016, CMS issued its final rule implementing the Affordable Care Act (ACA) requirement that providers and suppliers report and repay overpayments from Medicare, known as the "60-Day Rule."  The ACA requires a person who has received an overpayment to report and return the overpayment by the later of  (a) 60 days after the date the overpayment was identified; or (b) the date any corresponding cost report is due, if applicable.  Notably, the final rule imposes a look-back period of six years, a shorter time period than the ten year period set forth in a proposed version of the rul

July 2016

Eyes Wide Open to the Financial Opportunities

Maximizing Revenue, Avoiding Losses 

By: Victoria (Tue, Mar/15/2016) 

Healthcare professionals are being forced to move out of their comfort zones. Sweeping changes are being made to change the way healthcare is provided and paid for.

40% of in-network payments are tied to value. And the traditional fee for service model is expected to disappear over the horizon in the years to come. Payments based on quality of care are increasing and it is imperative for healthcare organizations to address the current, on the ground, challenges, posed by the VBP model.

Medicare oupatient hospital services are paid under the Outpatient Prospectivie Payment System (OPPS), under the Ambulatory Patient Classification system. Historically, these had been called Ambulatory Patient Groups (APGs), but before implementation of the OPPS on August 1, 2000, the name changed to APCs.