Greetings!
As of January 1, 2011 Blue Cross Blue Shield has offered a new Medicare Advantage PPO. Some patients enrolled in this Medicare Plus Blue PPO plan will have a higher out of pocket cost if they are seen at any Spectrum facility. Please continue reading for more information regarding these changes.
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Spectrum Health no longer in-network for some Blue Cross Blue Shield Advantage Plans.
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In July 2010, Spectrum Health made the decision not to sign a contract for Blue Cross Blue Shield of Michigan's Plus Blue PPO Medicare Advantage product. Spectrum Health contracts with BCBSM for all other products.
About half of the people enrolled in this product, including Michigan Public School Employees Retirement System members, have policies that will not be affected by additional out-of-network costs.
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Department of Veterans Affairs Audit Notice
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The Department of Veterans Affairs has a contract with Health Net Federal Services to conduct a review of claim payments to Non-Veterans Affairs providers. They will be reviewing the appropriateness and accuracy of VA payment of outpatient claims between October 1, 2009 and September 30, 2011.
Providers who receive a letter from Health Net Federal Services requesting medical documentation should comply with this request promptly.
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WPS Medicare Part B eNews Question
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From WPS Medicare Part B Legacy eNews for Monday, February 21, 2011:
WHAT IS THE CORRECT DATE OF SERVICE?
Question: My patient had a chest x-ray on Tuesday. I read the chest x-ray on Wednesday. I performed both services in my office. What date of service (DOS) do I use for the professional component (reading) of the chest x-ray? Does the answer change if I have performed both components or if a hospital or other entity performed the technical (the taking) component?
Answer: The Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-02, Chapter 15, Section 20 discusses when expenses are incurred. "Part B expenses for items are considered to have been incurred on the date the beneficiary received the item or service, regardless of when it was paid for or ordered." This instruction does not change based on who performed which components. The appropriate DOS for the professional component is the date the physician performed the interpretation.
Note: This mainly pertains to providers who are reading an x-ray or test and do not own the machine utilized for testing.
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