The Assignment form is a crucial document that you must obtain in order to serve as the authorized representative of the patient to pursue the patient’s rights under ERISA. In other words, ERISA is a right belonging to the patient – not the doctor – unless the doctor obtains an Assignment. Use the Form and article below for more information:
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The MPA requires 150 hours of CME for the licensing period, divided into 60 hours in Category I and 90 hours in Category II. For the renewal period in 2002 and thereafter, physicians will be responsible for 150 hours for the three-year licensing period earned during that period.
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he antitrust laws of the United States and the various states prohibit agreements, combinations, and conspiracies in restraint of trade. Business competitors are prohibited from engaging in actions that could result in unreasonable restraint of trade (i.e. price fixing).
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A few months ago, Aetna released a new policy indicating they will no longer pay for 97140 (manual therapy techniques) when performed on the same date of service as a CMT code (9894x). This even includes billings where the provider appends the -59 modifier (appropriately or inappropriately).
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The Office of Inspector General (OIG) Health & Human Services (HHS) of was established 1976 and has been at the forefront of the Nation’s efforts to fight waste, fraud, and abuse in Medicare, Medicaid, and more than 300 other HHS programs. The majority of OIG’s resources go toward overseeing of Medicare and Medicaid, and they develop and distribute resources to assist the health care industry in its efforts to comply with the Nation’s fraud and abuse laws and to educate the public about fraudulent schemes.
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How do I coordinate benefits in a Workers’ Compensation case that involves a Medicare patient?
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In general, Medicare FFS claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will incur a 2 percent reduction in Medicare payment. Claims for durable medical equipment (DME), prosthetics, orthotics, and supplies, including claims under the DME Competitive Bidding Program, will be reduced by 2 percent based upon whether the date-of-service or the start date for rental equipment or multi-day supplies, is on or after April 1, 2013.
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A large number of questions I receive deal with appealing denied insurance claims and these denials cause most doctors headaches. When a claim has been denied because of medical necessity or because a service is not covered, an important step in the appeals process is to determine if the patient’s plan is a self-funded ERISA plan.
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