Insurer Withdrawals Threaten More with Loss of Coverage

The individual market for health insurance – where approximately 20 million Americans purchase health policies – is insecure and unstable, according to America’s Health Insurance Plans (AHIP), a national trade association for approximately 1,300 health insurers. Writing to the Senate Finance Committee, Marilyn Tavenner, CEO and president of AHIP, said, it “clearly faces immediate and […]

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  • Psychologists Can Submit Quality Measures in 2017

    Because psychologists are exempt for the next two years from the Merit-Based Incentive Payment System (MIPS) for Medicare providers that rolled out in January, some are breathing sighs of relief with no worries of incurring financial penalties for not screening for conditions patients do not mention. They argue that the exemption will save time and […]

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  • Health Care Fraud Grabs Headlines; Psychologists More Often Troubled by Poor Documentation

    A national health care fraud takedown in the second half of 2016 resulted in criminal and civil charges against the most providers and largest amount of alleged fraudulent billing in Medicare history. In June, U.S. Attorney General Loretta Lynch and the Department of Health and Human Services (HHS) announced an unprecedented sweep led by the […]

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  • CMS Proposes Payment Model for Integrated Care

    A growing body of evidence suggests coordination and collaboration between primary care and behavioral health providers improves patient care and reduces costs, but the unanswered question has been how to pay for it. Beginning a year’s trial in January 2017, the Center for Medicare and Medicaid Services (CMS) has enabled providers who work in centers […]

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  • Telemedicine Conference Well-Attended

    Minneapolis – More than 5,000 health care providers, researchers, consultants, investors, information technology (IT) developers and exhibitors from more than 55 countries attended the American Telemedicine Association’s (ATA) 2016 Annual Conference and Trade Show here. The four-day meeting in May was filled with learning sessions, networking events and an exhibit hall unmatched by most professional […]

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  • Reimbursement Diagnoses May Be Co-Morbid: Ethical Concerns with Different Diagnoses

    I work in a sleep medicine clinic. Since the implementation of ICD-10-CM, I have had more cases where the diagnosis (for example: insomnia) is not accepted by insurance. My billing person has asked me for another diagnosis so she can rebill insurance. There are some cases where all I can do is give a different […]

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  • Health Care Reform: Republicans Face Headaches Replacing ACA

    Like many Americans, stakeholders in the health industry were stunned by Election Night 2016. Since virtually all pundits and polls had projected a victory for Democrat presidential nominee Hillary Clinton, the Affordable Care Act (ACA) was considered “a program that wasn’t going anywhere,” as Charles Kahn, the Federation of American Hospitals’ chief executive, described it, […]

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  • New ACA Rule: Burden or Irrelevant for Psychologists?

    Federal antidiscrimination rules promulgated by the Health and Human Services Office of Civil Rights that require many providers of health-related services to post notices in 15 languages that translation services will be provided free of charge to those who have trouble speaking and understanding English probably does not apply to most practicing psychologists. Emphasis on […]

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  • Medicare Payments to Focus on Value not Volume

    Psychologists will have a two-year reprieve from reporting quality measures for Medicare patients beginning January 2017, according to the Center for Medicare and Medicaid Services (CMS). The Physician Quality Reporting System (PQRS) that began in 2007 is being phased out in December. Although that may be a relief to those who opposed it, psychologists will […]

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  • CMS Wrongfully Denying Physician Quality Reporting System (PQRS) Incentives

    Due to the dogged determination and careful attention to detail of Amy Rosett, PhD, a solo practitioner from Encino, California, the Center for Medicare and Medicaid (CMS) overturned its decision to deny a financial bonus for her 2014 participation in the Physician Quality Reporting System (PQRS). Last September Rosett failed the Measure Applicability Validation (MAV), […]

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