Insurance news
Medicaid Enrollment Up by 9 Million in 2014
Written by Editor   
Wednesday, December 31, 2014 03:59 PM

More than a fifth of the U.S. population -- 21.2%, or 66.5 million people -- were receiving Medicaid physical health benefits during the third quarter of 2014, an increase of 9 million from the year before, according to a report from the consulting firm PwC (formerly PricewaterhouseCoopers).

Most of the growth came through Medicaid managed care plans, with 9.3 million people added to those rolls, while 300,000 fewer people were receiving traditional Medicaid coverage compared with the same quarter in 2013, the report found. 

New Timeframe for Medicare Responding
Written by Editor   
Wednesday, December 10, 2014 02:07 PM

Effective April 1, 2015, when a provider receives a pre-payment review Additional Documentation Request from a Medicare Administrative Contractor (MAC) or Zone Program Integrity Contractor (ZPIC), the provider will now have 45 calendar days to respond and supply the requested documentation. If the provider does not respond by day 46, the associated claims will be denied.

TDI-DWC 2015 Medical Fees Established
Written by Editor   
Wednesday, December 10, 2014 02:04 PM

The Texas Department of Insurance, Division of Workers’ Compensation reports in Commissioner’s Bulletin No. B-0023-14 that “Under Labor Code  Article 413.001(a), fee guidelines adopted by the Division of Workers’ Compensation for non-network services and approved out-of-network services are based on the most current reimbursement methodologies, models, and values or weights used by the federal Centers for Medicare and Medicaid Services."

“DWC established a conversion factor and an annual update … the annual update is based on the Medicare Economic Index, which is a weighted average of price changes for goods and services used to deliver physician services.  The Medicare Economic Index for 2015 reflects an increase of 0.8 percent."

“For services provided in calendar year 2015, the new Medical Fee Guideline factors are $56.20 and $70.54.  The conversion factor of $56.20 applies to service categories of evaluation and management, general medicine, physical medicine and rehabilitation, radiology, pathology, anesthesia, and surgery when performed in an office setting.  The conversion factor of $70.54 applies to surgery when performed in a facility setting."

What Is Considered by and Insurance Adjustor?
Written by Editor   
Wednesday, December 10, 2014 01:56 PM

What are some of the things that an insurance adjuster or claim representative will consider in considering a case?

On December 9, 2014, the Fourteenth Court of Appeals upheld a decision on appeal from the 11th District Court in Harris County Texas.  From this Appeals Court Decision several interesting points emerge that contribute to an answer of this question:

ACA Addresses Referral Requirement in UnitedHealthcare's New Charter Products
Written by Editor   
Wednesday, December 10, 2014 12:29 PM

ACA is following up on a recent communication from Optum Health to providers announcing the new UnitedHealthcare Charter products.  This portfolio of plans features three offerings with different levels of coverage - Charter, Charter Balanced, and Charter Plus. (These plans are not currently offered in all states, so this may not apply to your area.)  A referral from the patient's PCP is required for treatment to be covered under the Charter Plan, and a lesser benefit with a higher cost share is offered in the Charter Balanced and Charter Plus plans if the patient does not have a referral from their designated PCP to the doctor of chiropractic.  

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