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CMS: New Wait Time Requirements Beginning January 1, 2025

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A new ruling by CMS regarding the Qualified Health Plan (QHP) requires issuers to ensure that patients can schedule appointments within the time frames listed below at least 90% of the time: Behavioral Health: 10 business daysPrimary Care: 15 business daysSpecialty Care (Non-Urgent): 30 business days “Secret shopper” calls will be made by third party entities to conduct assessments in order evaluate compliance with these wait time standards in the areas of primary care and…
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Blue Cross Transition to Labcorp Delayed Until March 1, 2025

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Blue Cross has delayed its transition to LabCorp as the exclusive national laboratory and only Preferred Medical Laboratory Plus (PLMP) provider in the Preferred Medical Laboratory (PML) network until March 1, 2025. By delaying this transition, providers will have more time to transition their electronic interface to a participating laboratory. These transitions can take up to 60 days, so it is imperative that providers begin to transition now. Blue Cross has stated that the new…
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QPP Exception Applications NOW AVAILABLE for 2024

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CMS has announced that the 2024 Quality Payment Program (QPP) Exception Applications are available now through December 31, 2024 at 8pm ET. There are 2 types of exception applications for users who are unable to report data for one or more Merit-Based Incentive Payment Systems (MIPS) performance categories. MIPS Promoting Interoperability Performance Hardship Exception Application which can be filed for the following reasons: MIPS Extreme and Uncontrollable Circumstances Exception Application – these circumstances are defined as…
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Medication Reconciliation Post-Discharge

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As a reminder, the Medication Reconciliation Post-Discharge measure is displayed for Primary Care Select providers. This measure looks at the percent of members 18 and older with an inpatient admission during the measurement year for whom medications were reconciled from the date of discharge through 30 days after discharge (31 total days) from the first qualified admission during the measurement year by a prescribing practitioner, clinical pharmacist or registered nurse. Patients who used hospice services…
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Patient Billing Best Practices

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Collecting patient balances in a medical billing environment requires a systematic approach to ensure timely and efficient payment. Not only is it necessary to be persistent, but also to remain committed to the best patient communication techniques. Patient engagement when it comes to payments should rank at the top of the list in importance for a financially healthy practice. Listed below is a helpful,  step-by-step guide on how to best manage and collect patient balances:…
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Industry Updates – in case you missed them!

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Blue Cross: Star Score Preview Coming Soon to Provider InsightsDuring the fourth quarter of 2024, Provider Insights will begin displaying a prospective star score for Quality. There will be a preview period through 2025 and become effective for scoring in the first quarter of 2026. This prospective star score will be used to determine the value-based payment for meeting Quality thresholds. This impacts primary care providers, including pediatricians as the shift to star score methodology…
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A Longstanding MediSYS Tradition – Taking Care of Clients

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With almost 40 years of experience in serving medical practices, MediSYS’ primary strength goes far beyond its quality products and continued efforts to create the easiest, most dependable software in the industry. Ask their clients and they will tell you. What sets them apart is outstanding support. For decades, MediSYS has focused on taking care of its clients. With a staff of experienced support professionals, the company works to solve problems as quickly as possible…
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Blue Cross Updates the Preferred Medical Laboratory (PML) Network

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Blue Cross Updates the Preferred Medical Laboratory (PML) Network Blue Cross and Blue Shield of Alabama has designated Labcorp as the only PMLP provider in the PML network and the exclusive national laboratory effective December 1, 2024. Blue Cross announced that as the only designated PMLP provider, Labcorp is working with them to provide low costs to their members, as well as to maintain a high standard of performance and quality. Blue Cross recommends that…
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Important MIPS Updates for 2024

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Attention MIPS Participants: Several of the traditional MIPS measures have been removed from reporting as of 2024. They are listed below: CMS 69 BMI Screening and Follow Up CMS 125 Breast Cancer Screening CMS 127 Pneumococcal Vaccination CMS 130 Colorectal Cancer Screening CMS 147 Influenza Immunization Many of these are common options for reporting therefore your office will need to review the current 2024 list and find other measures to report on for this year….
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MIPS 2024: A Comprehensive Guide for Healthcare Practitioners

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With the ever-evolving landscape of healthcare, it is crucial for healthcare practitioners to stay informed about the latest payment systems and regulations. One such system that practitioners need to be familiar with is the Merit-based Incentive Payment System (MIPS). In this comprehensive guide, we will delve into the key aspects of MIPS 2024 and provide healthcare practitioners with the knowledge they need to navigate this payment system effectively. What is MIPS? MIPS, short for Merit-based…
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