Your ConnectiCare patients with commercial and Medicare Advantage plans effective on or after Jan. 1, 2017, will have new member ID cards. We will also be issuing new member ID numbers to all of your ConnectiCare Medicare Advantage patients. The redesigned member ID cards will make it easier for your office to identify the different product names, copayments and where you should send your claims for payment. It will also clearly note whether referrals are needed...

This is the last year for reporting of the PQRS Quality Measures as we know it today. In 2017, the Merit-Based Incentive Payment System (MIPS) will go into effect combining several programs into one. Please refer to our prior Provider News and Alert publication dated October 14, 2016 for more information. If you are submitting your 2016 PQRS Quality Measures via the claims method and are unsure if you will be a “successful reporter,” to avoid...

On Wednesday, November 2, 2016, CMS finalized revisions to payment policies under the physician fee schedule along with other revisions to Part B for calendar year 2017. These changes are scheduled to be published in the Federal Register on November 15, 2016. These revisions and regulations will be effective on January 1, 2017. Among these changes, the final rule outlines: Changes for the 2017 calendar year physician fee schedule for physician services: The current 2016 conversion...

According to the Center of Disease Control and Prevention, receiving an annual flu vaccine is the greatest method in protecting against the spread of the flu. The more people who get vaccinated, the more people who will be protected. Who should be vaccinated? All persons should receive the flu vaccine but the following groups are at high risk: Older people and those that live with and care for them Very young children and those that live with...

HHS finalizes streamlined Medicare payment system that rewards clinicians for quality patient care MACRA rule will accelerate health care system’s shift toward value Today, the Department of Health & Human Services (HHS) finalized a landmark new payment system for Medicare clinicians that will continue the administration’s progress in reforming how the health care system pays for care. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program, which replaces the flawed Sustainable Growth Rate (SGR), will equip...

Under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, CMS is required to remove all Social Security Numbers from Medicare Cards by April 2019.  On September 28, 2016, CMS issued notice of its intent to discontinue the use of Social Security Numbers on Medicare cards beginning April 2018.   CMS will change to a randomly generated Medicare Beneficiary Identifier (‘MBI’) which will replace the prior SSN-based Health Insurance Claim Number (HICN).  The goal is...

Medical Billing and Coding - Healthcare Coding There are two changes occurring on October 1, 2016, that will affect ICD-10 coding: First, there are 1943 new ICD-10 CM codes slated to go into effect 10/1/2016, along with 422 revised and 305 deleted ICD-10 CM codes. These numbers are quite remarkable, and due primarily to a code freeze for the past several years while ICD-10 was planned and implemented. The second and equally important change to note is...

The Merit-Based Incentive Payment System (MIPS), a component of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), will change how clinicians (previously known as Eligible Professionals) are reimbursed for Medicare beneficiaries. This new payment system is scheduled to go in effect 1/1/2017 as outlined in the proposed law. The final rule is expected to be published no earlier than November 1, 2016. The MIPS combines several federal quality programs including Physician Quality Reporting System...