Centers for Medicare & Medicaid Services (CMS) will turn on the Phase 2 denial edits, Effective May 1
The Affordable Care Act, Section 6405, “Physicians Who Order Items or Services are Required to be Medicare Enrolled Physicians or Eligible Professionals,” requires physicians or other eligible professionals to be enrolled in the Medicare Program to order or refer items or services for Medicare beneficiaries. Some physicians or other eligible professionals do not and will not send claims to a Medicare contractor for the services they furnish and therefore may not be enrolled in the Medicare program. Also, effective January 1, 1992, a physician or supplier that bills Medicare for a service or item must show the name and unique identifier of the attending physician on the claim if that service or item was the result of an order or referral. Effective May 23, 2008, the unique identifier was determined to be the National Provider Identifier (NPI). The Centers for Medicare & Medicaid Services (CMS) has implemented edits on ordering and referring providers when they are required to be identified in Part B, DME, and Part A HHA claims from Medicare providers or suppliers who furnished items or services as a result of orders or referrals.
Video: Doctors No Longer Accepting Medicare Patients in North Carolina
McCrory, Wos announce plan to privatize Medicaid
As has already been pointed out, the profit motive is the driving force behind successful (my word) business models, and in the pursuit of profits, the business owner dispenses her resources in an attempt to maximize her personal profits. It happens to be that in this particular case the profit-seeking, business owner has at her disposal the power of the legislature. Now that is hopefully not a resource under her direct control, but through the lobbyists, which have already been mentioned, the business owner has her republican and democrat friends (puppets?) legislate taxpayer money into her pockets under the auspice that it wil bring relief to the poor and otherwise needy or downtrodden portion of the population. Perhaps we should consider taking that power from the business owners and forcing honest business to procede as much as is possible.
Dueling editorials on Medicaid privatization
A long line of cases by the United States Supreme Court have held that when a state delegates a decision making function to a private entity, even though the state may still make the rules, the due process rights of the individual miraculously disappear. In the 1970’s and 1980’s New York had a tiered system for providing institutional care for the disabled elderly: Skilled nursing services provided in Skilled Nursing Facilities, custodial services provided in Health Related Facilities, and congregate care provided in Adult Homes. When the local Medicaid agency decided to move someone between the three types of facilities, the individual did not get notice or a right to appeal. Legal services programs challenged in federal court this lack of due process. The state acquiesced and agreed to give full due process rights including fair hearings with aid continuing pending a final determination before transferring a resident between levels of care. It then immediately turned around and delegated the decision making process to the Utilization Review Committees of the nursing homes and again denied due process and appeal rights this time based on the theory there was no longer any state action in the decision making process.
McCrory offers plan to privatize NC Medicaid risk
NC’s Medicaid system works and apparently well when compared to other states. That said – a recent Time magazine article clearly pointed out the problems with a lot of medical costs and its not at the medicare/caid level or the state level it’s in the billing at the hospital. By injecting a private, for profit enterprise into the mix we will only substitute profit costs for administrative costs and we will lose control of it completely. I’m all for free markets, but as the Time magazine article indicates the free market for medical care is not working. You need to subscribe to read the entire article but here’s some highlights from it:
Medicare Committee Meeting with Palmetto
Diamond Level Platinum Level Gold Level Biz Technology Solutions, Inc. First Citizens Bank rmsource, Inc. Wells Fargo Insurance Services Silver Level Ball Dermpath Ford & Harrison McGladrey Medical Protective SunTrust Bank United HealthCare Group Bronze Level Allegacy Business Solutions – JBA Benefits & Cooperative Payroll Allscripts Apex Technology Assured Waste Solutions, LLC Bactes Imaging Solution Bernard Robinson & Company, LLP Call-A-Nurse Capario ChoiceHealth, Inc. Coverys, Inc. DataMax Corp / Interstate Credit Collections Fifth Third Bank Eastman Kodak Company GMK Associates, Inc. Gordon Asset Management, LLC Greenway Medical Henry Schein Medical Konica Minolta LabCorp Marketing Works McNeary, Inc. Medicus Insurance Company Medstaff National Medical Staffing mindShift Technologies, Inc. MSOC Health NCHA Strategic Partners NextGen Healthcare ONLINE Information Services Physician Discoveries Physicians’ Alliance of America Prince Parker & Associates Professional Recovery Consultants SCA Collections, Inc. Solstas Lab Partners SouthData Stanley Benefits Stern & Associates, P.A. Attorney at Law The Doctors Company Total Merchant Services Transworld Systems TriMed Technologies Corp TriZetto Provider Solution – Gateway EDI
North Carolina GOP lawmakers work to block Medicaid coverage expansion