The ICS previously placed several formal inquiries to CMS regarding clarification for Clinical Summaries (Measure 13, Stage 1). We made the inquiries because the language in many of their publications was ambiguous and left providers uncertain. However, CMS recently released a statement with greater clarification:
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BCBS has indicated, “Initially the program will apply to BCBSIL PPO members who are fully insured.” According to the Employee Benefit Research Institute, “In a fully insured plan, the employer pays a per-employee premium to an insurance company, and the insurance company assumes the risk of providing health coverage for insured events.” Roughly 45% of insured patients are fully insured. However, BCBSIL has indicated that the program may be expanded to other plans after the initial period.
Read MoreMany of you are aware of the recent announcement from Blue Cross Blue Shield of Illinois regarding their contract with Orthonet to perform Utilization Management across the state of Illinois, to commence sometime in 2013. If you are not aware, please read the article in the October 2012 BlueReview.
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As small business owners, many of you are torn between the rigors of practice and the actual running of the business. After dealing with the incompliant patient, many of you find yourselves on the phone with the difficult insurance company or demanding personal injury attorney. Lost in the fray of practice (as I can get lost in the fray of running an association), doctors forget to lead. We forget that we are not in this alone.
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It has already been a busy year for Illinois chiropractic physicians in a variety of ways, not the least of which is the passage of two major pieces of legislation. This August 2011 edition of the ICS Journal is appropriately titled “A Breath of Fresh Air.” As an idiom, this phrase indicates a new, fresh, and imaginative approach. The ICS has taken a new approach to legislative issues, oxygen therapies, scope of practice, education and now soldiers – our heroes.
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The 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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