Georgia’s Department of Community Health (DCH) is beginning the implementation of a phased centralized prior authorization function for traditional Medicaid and the three CMOs (Amerigroup, Peach State Health Plan and WellCare). This centralized PA will be available on the Georgia…
The Affordable Care Act (ACA) requires that all physicians or other practitioners who prescribe or order services for Medicaid recipients or who refer Medicaid recipients will have to be enrolled as a Medicaid provider. Services that are rendered based on…
Pursuant to the Affordable Care Act, physicians who provide a majority of primary care services to Medicaid beneficiaries are eligible to receive increased reimbursement on these services for their Medicaid beneficiaries for 2013 and 2014. The Department of Community Health…
The mandatory sequester or reductions in federal spending mandated by the Budget Control Act of 2011 continue to roll out. CMS has published an update concerning the mandated reductions to the Medicare EHR Incentive Program. Under the sequester, the Medicare…
On 4.1.2013, Georgia Medicaid posted the provider notice below regarding an update to their Health Check (EPSDT) services. The notice provides guidance on billing vaccine administration codes along with the necessary modifiers in conjunction with Health Check services. Please note…
Yesterday, the Senate passed a spending plan package to prevent the scheduled federal government shutdown scheduled for March 27, 2013. The spending package will keep the government financed to run through September 1, 2013 and now goes to the House…
The White House has just released the annual Economic Report of the President; which featured an interesting graph detailing the projected amount that Medicare spending will account for in the total GDP between 2013 and 2085. http://www.washingtonpost.com/blogs/wonkblog/wp/2013/03/15/want-to-debate-medicare-costs-you-need-to-see-this-chart-first/ Based on the…
As mandated by prior federal legislation, mandatory cuts in federal spending were enacted through sequestration on March 1, 2013. The sequestration cuts will impact the Medicare fee for service fee schedule, effective for claims with dates of service of April…
As we move closer to the rollout of the health insurance exchanges, health insurance carriers are beginning to prepare their product offerings to offer either within the health insurance exchange or as a competitive product to the health insurance exchange…
SHP is excited to announce that we now provide both consultation and management services for primary care providers who are interested in forming an ACO (Accountable Care Organization). Based on the continuing market transition under healthcare reform, SHP strongly believes…