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Patient Eligibility

“Eligibility” is not what it once was! Commercial health plans have HMO’s and PPO’s and various other plan types, they also have various products within those categories, and just to make it more complicated some plans have plans within the plan specific to a given employer or group’s requirement. The Affordable Care Act has added…

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Notice of Material Change

Seems to be the Season for the Notice of Material Change! The health plans are required to send out a NOMC anytime there is a change that may affect provider compensation.  Times, must be a changing, as we are seeing an unprecedented number of NOMC notices. Managed care contracting is, increasingly, more about strategy than…

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It’s pool season, no diving in the shallow end…

S06.0X0A — Concussion without loss of consciousness S01.01XA — Laceration of scalp W16.022A — Fall into swimming pool, striking bottom and causing injury Y93.12 — Platform diving In preparation for the upcoming deadline for ICD-10 implementation, RT Welter presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and…

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May in Colorado…

L55.2 — Sunburn of third degree Y93.17 — Water skiing T33.531A — Frostbite of fingers Y93.23 — Snow skiing In preparation for the upcoming deadline for ICD-10 implementation, RT Welter presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation…

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CMS Begins Restructuring Of Quality Improvement Program

The Centers for Medicare & Medicaid Services (CMS) has taken its first step toward improving its efforts to ensure the effectiveness, efficiency, economy, and quality of care quality for Medicare beneficiaries in through the Quality Improvement Organization (QIO) Program. Last week, the federal agency announced the selection of Livanta LLC and KePRO as Beneficiary and…

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ICD-10 End-To-End Testing Cancelled

ICD-10 Compliance Date On April 1, 2014, the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93) was enacted, which said that the Secretary may not adopt ICD-10 prior to October 1, 2015. Accordingly, the U.S. Department of Health and Human Services expects to release an interim final rule in the near…

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