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  • 2019 Telehealth Expansion Under Medicare
    The Medicare SUPPORT scheme has been updated and all providers of Medicare-approved services should endeavor to make themselves aware of the new rules and regulations that the changes will entail. The changes will primarily be of effect in regards to those Medicare beneficiary patients who are simultaneously suffering from co-occurring mental health disorders or otherwise a substance use disorder.
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What’s new

New AIM Rehabilitative program effective July 1, 2019
Empire will be transitioning from OrthoNet LLC to AIM Specialty Health® in its bid to better manage its medical necessity reviews. It will also be adding speech therapy to its list of services for a more holistic rehabilitative review. Learn more about the program now!
Update regarding evaluation and management with modifier 25 same day as procedure when a prior E/M for the same or similar service has occurred
To prevent double billing and inefficient service duplication payouts, Empire may start denying Evaluation and Management service on the same day as the procedure. Learn more about reprocessing a claim for an unrelated E/M service now!
Online registration processes for electronic funds transfers and electronic remittance advices
Starting June 1, 2019, Empire will be updating its provider payment disbursement process. If you are currently using Change Healthcare and PaySpan for electronic fund transfers and electronic remittance advice, now would be the time to contact Empire for more details regarding the change.
Fidelis Authorization Grids effective April 1, 2019 are available
To provide the best level of service, Fidelis periodically reviews its authorization requirements for all lines of business. Review the most updated regulations now to avoid facing denials for unauthorized services.
MagnaCare Announces Collaboration with BeaconLBS to Help Physicians Select Laboratory Tests that Can Improve Patient Care and Reduce Costs
MagnaCare has entered into an agreement with BeaconLBS to bring BeaconLBS’ Physician Decision Support ® solution to its network of doctors and laboratory providers. See how this elevates MagnaCare’s health plan management services now!
Specimen Validity Testing Billed in Combination with Urine Drug Testing
It has been revealed that some Medicare payments to clinical laboratories and providers for specimen validity tests did not comply with the existing Medicare billing requirements. Review the OIG report now and see if your clinic is complying with the current billing requirements.
Medicare Preventive services: Screening Pelvic Examinations (includes a clinical breast examination frequency change)
If you are a female Medicare beneficiary at high risk for developing cervical or vaginal cancer, following up on routine preventive exams is necessary. Look up your Medicare preventive benefits now and see if you qualify.
NYC's Guaranteed Health Care Plan
NYC will be enacting a guaranteed health care plan to provide a bigger and more comprehensive health plan for all New Yorkers. Through NYC Care and Public Option, NYC has taken an unprecedented approach in tackling health local health services. Learn more about your new coverage now!
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Insights
April 2019