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MASS HEALTH REFERRALS

BY LEANNE WRIGHT Starting next week we need to make sure that MassHealth patients enrolled in managed care plans and have referrals are being billed with the PCP as the Referring MD provider. In the past as long as the referral number is attached, they’ve processed. Now we Also need to make sure the PCP… Continue Reading →

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LAST DAY FOR INFORMAL REVIEW REQUEST

BY DIANE DESANTIS The 2015 Annual Quality and Resource Use Reports (PQRS) were released on September 26, 2016. The 2015 Annual PQRS show how physician groups and physician solo practitioners performed in 2015 on the quality and cost measures used to calculate the 2017 Value Modifier as well as their 2017 Value Modifier payment adjustment…. Continue Reading →

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PHYSICIAN QUALITY REPORTING SYSTEM 15 Days Remaining to Submit an Informal Review for 2017 Physician Quality Reporting System Results

BY DIANE DESANTIS In 2017, CMS will apply a downward payment adjustment to those who did not satisfactorily report PQRS in 2015 including: Individual eligible professionals (EPs) Comprehensive Primary Care (CPC) practice sites PQRS group practices Accountable Care Organizations (ACOs) If you have any questions regarding the status of your 2015 PQRS reporting or are… Continue Reading →

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Credentialing Blues

By DIANE DESANTIS After 35 years in the business of medical practice administration, I still do not understand why clinicians have so much difficulty understanding insurance carrier credentialing. Everyone in the world knows that the money from a medical service insurance claim comes from an insurance company. How does the insurance company know who to… Continue Reading →

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New Client Offer

BY LOLLIE WEEKS Get over 30 years expertise in medical coding & billing, staff training and practice management consulting and save. Sign a one-year contract with NEARM, New England’s leading billing agency and get a discounted 6% service fee on our first year service fee. This special offer is good through February 28, 2018 and… Continue Reading →

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Revalidation for Medicare and Medicaid

BY DIANE DESANTIS Have you received a letter from CMS requesting immediate response for revalidation? Both Medicare and Medicaid programs are now requiring that physicians be revalidated every 2-3 years. Who in your office has the time and expertise to complete these forms? Who has the time and experience to track their progress and answer… Continue Reading →

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