Beginning with dates of service on or after Jan. 1, 2019, UnitedHealthcare, aiming to minimize out-of-pocket costs for its members, will review the site of care during their Outpatient Radiology Prior Authorization process. This is being instituted, many believe, to allow UHC to direct patients away from outpatient hospital settings and into outpatient freestanding imagingREAD MORE
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Recovery audit contractors are hoping a new report on their past success recovering money for Medicare will cause CMS to reverse course on its decision to limit the number of claims they can review.READ MORE
CMS is proposing to pay a standard reimbursement rate for E/M levels 2 through 5. CMS is also proposing many changes to the documentation requirements for E/M visits.READ MORE
Starting Aug. 6, Blue Cross and Blue Shield of Texas will no longer pay for out-of-network emergency room visits in which the insurer determines the patient should have sought treatment elsewhere.READ MORE
On July 12, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that includes proposals to update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2019.READ MORE