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  • What Is The New York State Patient-Centered Medical Home And How Will It Help?
    As part of ongoing attempts to personalize patient care, the New York State Patient-Centered Medical Home promotes the importance of physicians and patients working in collaboration for the organization of health care needs. It provides reimbursement opportunities and is designed to improve a patient’s experience of the healthcare experience.
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Your Questions Answered
How long medical records should be kept? Is functional limitation reporting required on therapy claims in 2019?
You’ve got questions, but don’t worry; we are here to try to help you. As experts in our field, we at WCH can help you to find the right solutions to your problems or concerns.
What’s new

Claim Rejection and Denials for Providers on the Preclusion List started in April 1, 2019
Plans to reject or deny Medicare claims for Part D drugs and MA services have been unveiled. These plans will be in effect for providers on the Precaution list. Learn how they will affect you and your medical services and operations.
Choosing a Primary Clinician in MyMedicare.gov: New Video for Your Patients
For Medicare patients who have never chosen a Medicare practitioner before, the choice between different health care providers can be a hard one to make. A new advisory video for Medicare patients has been released to change that.
Opioid Treatment Plan
The documentation regarding the administration of opioids has been changed. Health care providers should make themselves aware of the update and work to understand its implications fully.
Reminder: Revalidation of Medicaid Providers is Required
Every five years, all Medicaid providers must revalidate their account information. This is as set out by the New York State rules and Federal Regulation 42 CFR (Code of Federal Regulations).
Maintaining and Updating Your Enrollment Records for your Medicaid Program: A Telephone Number is Required for All Service Addresses
Changes to the Medicaid Program mean that health care providers must provide a telephone number for each service address. Providers should work to ensure that they understand the implemented changes for an easy transition process.
Update: UnitedHealthcare updates Consultation Services Policy, Professional
Recent updates have been applied to the UnitedHealthcare program and it’s Consultation Services Policy. The changes set out that certain CPT codes will not be eligible for reimbursement. Health care providers should revise and understand the new changes in order to provide a continually effective service.
Metroplus – Disallowance project.
Third-party coverage for Medicaid members of the HMS scheme will now be covered by MetroPlus. MetroPlus will serve to assist HMS in identifying and recovering funds from associated third parties.
Empire: Referral to specialists is required for Gatekeeper plans
New plans implemented at the turn of the year will affect both the Individual Pathway Networks and the new Blue Access network. The plans are designed to set out new rules for claims made without the use of a referral from a suitably qualified referee.
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Insights
March 2019