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Medical Practice Management & Consulting
NewsWire                                                                                         September 2010
In This Issue
Expansion of Preventive Services by Private Insurances
Health Reform Provisions Take Effect September 23
Expansion of Mandatory Preventive Services under Private Insurance
Doctor on-callAll new health plans must cover certain preventive services with a rating of "A" or "B" - as recommended by the U.S. Preventive Services Task Force (USPSTF) - without charging a deductible, co-pay or co-insurance (effective for health plan years beginning on or after September 23, 2010).

Covered services include:
  • Mammograms, colonoscopies and other cancer screenings.
  • Blood pressure, diabetes and cholesterol screening.
  • Lifestyle counseling (quitting smoking, losing weight, eating better, treating depression and reducing alcohol use).
  • Counseling and screening for healthy pregnancies.
In addition, immunizations recommended by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices, including influenza and pneumonia, regular well-baby and well-child visits must be covered. Under an interim final rule released by the U.S. Departments of Health and Human Services (HHS), Treasury and Labor, services must be provided by an in-network physician in order to be covered. Comments on the rule are due September 17, 2010.
"The results of quality work last longer than the shock of high prices."
                  Author Unknown
OIG launched a new on-line form for anyone to report fraudulent activity

Anthem Blue Cross's payment policies in effect as of August 23, 2010

ICD-9-CM will be replaced by ICD-10-CM on October 1, 2013. Are you going to be ready?
CME Certification for Physicians is every 2 years...
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Health Reform Provisions Take Effect September 23, 2010
Many of the provisions of federal health care reform, passed and signed into law last spring, take effect on September 23, 2010.  These provisions include:
  • Lifetime/Annual Limits: The law prohibits lifetime limits on health on health care benefits.  Annual limits on benefits are restricted to no less than $750,000 beginning September 23, 2010, and then gradually phase out until January 1, 2014, when they are completely banned.
  • Emergency Room Patient Protections: The law prohibits requiring prior authorization or higher cost sharing for out-of-network emergency services. 
  • Ob-Gyn Patient Protections: The law prohibits requiring a referral to see an OB/GYN.
  • Preventive Health Services: The law requires first dollar coverage (no co-payment or deductible) for certain preventive services.
  • Dependent Coverage: The law requires insurers to allow adult children under the age of 26 to stay enrolled under their parents' or guardians' health plan.
  • Preexisting Condition Exclusions for Children: The law prohibits denying coverage to individuals under the age of 19 based on a preexisting condition.
  • Rescission: The law prohibits insurers from rescinding coverage except in cases where the patient commits fraud or intentional misrepresentation of facts.
  • Appealing Insurance Company Decisions: The law provides consumers with a way to appeal coverage determinations or claims to their insurance company, and establishes an external review process.
 For more information on these and other health care reform provisions, click here.
If you are interested to find out more about any of the topics mentioned, please do not hesitate to send us an email at or call us at (888) 549-1713.
Med-Pro Management, Inc.

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