From 26th August 2019 onwards, Blue Cross and Blue Shield of Texas is updating its in-house review process for behavioral health claims that need benefit preauthorization. This should be taken into consideration that updates are for the claim review process only. There is no change in Benefit preauthorization required by particular services and the process for submitting benefit preauthorization requests.
How does these changes have an impact? It must be ensured that claims are billed properly. Remember, for all claims:
CMS originate a new audit phase in 2019 and believe the length will be consistent with preceding phases. While sponsoring organizations are usually audited once per audit cycle, CMS can audit a sponsoring organization more than once throughout the cycle based on risk or audit referral.
Indianapolis-based health insurance giant Anthem Inc. announced Thursday that it has agreed to buy Beacon Health Options—the largest independent behavioral health organization in the country—for an undisclosed price.
Anthem plans to buy Boston-Based Beacon Health Options, the country's largest independently held behavioral health provider. Beacon cares for about 36 million people across all 50 states with 3 million enrolled in a comprehensive risk based model. According to anthem, acquiring Beacon aligns with Anthem's broader strategic goal of expanding further into the provider space and integrating services more fully.
Acquisition will allow it to offer integrated behavioral and physical healthcare services to customers Nationwide. Beacon will be combined with Anthem's existing behavioral health business.
"Memorial Day is the holiday for honoring, commemorating & celebrating the people who have lost their lives serving for the United States of America's Armed Forces.
Memorial day is said to have been founded by the 16th President of the United States of America - Abraham Lincoln, for the 1863 cemetery dedication at Gettysburg."
The Texas Health and Human Services Commission (HHSC) is preparing to roll out its new provider and enrollment system. With the help of associating and switching some processes and systems, the new Provider Management and Enrollment System (PMES) will reduce administrative burden for providers.
The following processes and systems will be consolidated into the PMES system:
PMES Rollout Timetable and Feedback Opportunity:
Throughout 2019, the HHSC will be preparing for a March 2020 implementation of the new system:
Benefits of New PMES System for Providers
Here are some of the key strategies in order to explore your organization can execute to gain the upper hand in the new healthcare marketing landscape.
1. Be online to gain attention.
Undoubtedly — attention has shifted to the internet. In fact, 88 percent of U.S. adults use the internet today, in contrast to merely 52 percent in the year of 2000, according to data from Pew Research Center. And this trend is not restricted to youngsters: People of USA age 65 and older have been identified as the demographic with the fastest internet usage adoption rate since the year of 2000.
The facilities of Healthcare industry address the health requirements of individuals and are supposed to treat the sick under all conditions. Although, for any agency to sustain viable and continue to give services, it requires being paid for the services given – complete and in time. Agencies have to work with several payers, for instance payers like Medicare and Medicaid in order to get their just dues. Payer enrollment, till some years back, wasn’t considered important by the professionals of healthcare as important for building their practice. Today, although, it is not just essential, but almost imperative for clinicians to be enrolled with the proposed companies of insurance.
PROS AND CONS: DIFFERENCE BETWEEN IN-HOUSE & OUTSOURCED MEDICAL BILLIN
The key query of either to outsource the operations of medical billing or keep the procedure in-house is one that relies on several doctors and practice managers. The answer to this query varies with practice to practice depended on several factors: business’s age, local labor market’s size, and practice finances’ state, among other considerations.
The United States Department of Health and Human Services' Office of Inspector General ("OIG") disclosed the 2 new Work Plan items regarded to digital health in July 2017: first, a review of Medicare incentive payments for meaningful use (MU) of electronic health records (EHRs) ; and second, telehealth reimbursement’s review under the Medicare Part B
The precision of $14.6 billion in meaningful use payments is made to hospitals by Medicare will be reviewed by the Department of Health and Human Services Office of Inspector General between the time period of 2011 and 2016. The OIG estimated physicians were inaccurately paid $729 million under meaningful use (MU) earlier this year.