Archive for November, 2012

FTC Amends Rule on Identity Theft “Red Flags”

The Federal Trade Commission (FTC) announced on November 30, 2012 the publication of an Interim Final Rule on identity theft “red flags” that narrows the circumstances under which creditors are covered by the Rule.

Congress directed the FTC, along with several banking agencies to develop regulations requiring “financial institutions” and “creditors” to develop and implement a written identity theft prevention program.   By identifying “red flags” for identity theft in advance, businesses can be better equipped to spot suspicious patterns that may arise — and take steps to prevent potential problems from escalating into a costly episode of identity theft.

The Commission is seeking comment on the Interim Final Rule for 60 days.  After the expiration of the 60-day comment period and a review of the comments received, the Interim Final Rule will become final.   

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New ACA Administrative Simplification Rules Go Into Effect Soon

Starting Jan. 1, health plans will be required to support new operating rule standards for insurance eligibility verification and claim status electronic transactions.  The new operating rules will provide greater uniformity of information and transmission formats so that practices can use one type of request for all insurers rather than being required to use multiple systems.  In addition, under the new rules, practices will get a more detailed response when they ask about the status of a claim they have submitted to a health plan.

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CMS Releases Final Rule On Medicaid Primary Care Payments

The Centers for Medicare & Medicaid Services (CMS) released a final rule outlining higher Medicaid payments for primary care in 2013 and 2014. CMS will pay certain physicians the Medicare fee schedule rate (or, if higher, the rate using the 2009 conversion factor and the 2013 and 2014 RVUs) for designated Medicaid primary care services. These services include E&M codes 99201 through 99499 and CPT vaccine administration codes 90460, 90461, 90471, 90472, 90473 and 90474.

States will pay for services furnished by a physician, or under the personal supervision of a physician, with a specialty designation of family medicine, general internal medicine and pediatric medicine or a subspecialty recognized by the American Board of Medical Specialties, the American Board of Physician Specialties or the American Osteopathic Association