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Welcome to Global Integrated Reimbursement Services’ blog. The purpose of our blog is to allow access to a repository of issues that our company tracks regarding the reimbursement for pharmaceuticals, medical devices, diagnostics, biologics, and biosimilars. Also, it shows you how we can assist you in these areas.

Most Recent Articles

WellCare Expands Medicaid Market with Care1st Acquisition

Posted by on Dec 7, 2016 in Payer Coverage | Comments Off on WellCare Expands Medicaid Market with Care1st Acquisition

WellCare Health Plans Inc. announced its intentions to buy Care1st Health Plan of Arizona, an Arizona Medicaid Managed Care plan, for $157.5 million. As of now, more than half of WellCare’s 2.43 million Medicaid members reside in Florida and Georgia, states that have not expanded Medicaid under the Affordable Care Act (ACA). This deal will allow WellCare “an opportunity to expand our footprint into Arizona’s growing Medicaid and Medicare markets,” said Ken Burdick, WellCare’s chief executive officer. The deal is expected to close in early 2017. “Care1st Arizona is a well-regarded, quality health plan that has served government-sponsored programs in Arizona for more than 13 years. Its focus on community-based relationships and integrated delivery of medical care and social services aligns with our approach to providing improved health outcomes for low-income families, children, the disabled, seniors and individuals with complex medical needs,” said Ken Burdick, WellCare CEO. WellCare has not previously operated Medicaid in Arizona. With this acquisition, WellCare is expanding their Medicaid market by over 500,000 members who are Arizonans who have gained Medicaid coverage as a result of their state’s Medicaid expansion. Our Payer Advocacy Compass™ (PAC) team is tracking this acquisition as well as other acquisitions and mergers. For details of other acquisitions and mergers that GIRS is following, visit Payer...

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GIRS’ Six Tips for Successfully Adopting a Medical Technology Contact Support Center

Posted by on Nov 16, 2016 in Hotline Successes | Comments Off on GIRS’ Six Tips for Successfully Adopting a Medical Technology Contact Support Center

Within constantly changing payer landscapes and payer requirements, a reimbursement hotline staffed with dedicated reimbursement experts bridges the gap between providers, manufacturers, and payers. Such a dedicated reimbursement team can play an invaluable role to educate providers on submitting clean claims, appealing denials of coverage and payment, as well as other payer requirements. Selecting such an expert team to help providers stay informed of your Product’s coding, billing, and coverage requires careful consideration. The following is a list of tips to help guide you in your decision. Tip #1 – Verify the contact center employs sound standard operating procedures (SOPs), Protected Health Information (PHI) policies, training and implementation programs and staff members that are knowledgeable and passionate about policy and compliance. Tip #2 – Ensure that call center staff training focuses on competent provider support that will in turn improve patient access and product adoption. Tip #3 – Understand how the center can support your Products and therapies today and in the future. Tip #4 – Ensure that the call center can customize services to your unique company needs within compliance requirements. Tip #5 – Verify the contact platform offers omni-channel support across all common modes of communication such as fax, secure HIPAA compliant email and telephone. Tip #6 – Ensure that the call...

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CMS Releases Medicare Physician Fee Schedule for Calendar Year 2017. See What is New for Your Accounts…

Posted by on Nov 7, 2016 in Payment System | Comments Off on CMS Releases Medicare Physician Fee Schedule for Calendar Year 2017. See What is New for Your Accounts…

On November 2, 2016, the Centers for Medicare and Medicaid Services (CMS) released the final Medicare Physician Fee Schedule (MPFS) for 2017. The Final Rule updates payment policies and payment rates for services furnished by physicians and other practitioners in all sites of service under the MPFS. These services include but are not limited to visits, surgical procedures, diagnostic tests, therapy services, and specified preventive services. These policy changes and payment rates are effective as of January 1, 2017....

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Patient Access to Critical Care Improves when Insurance Coverage Expands

Posted by on Nov 4, 2016 in Uncategorized | Comments Off on Patient Access to Critical Care Improves when Insurance Coverage Expands

Many stakeholders in healthcare have one common goal: providing quality care to patients who need it. Having access to health insurance is key for improving patient access to much needed care. The state of Massachusetts (MA) serves as a unique example of how when insurance coverage expands, care improves. Colorectal cancer is the third most common cancer and the third leading cause of cancer-related deaths among adults in the United States. In a recent study, after the state expanded...

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GIRS Tracks Impact of Health Insurer Mergers on Patient Access to your Medical Technologies

Posted by on Oct 20, 2016 in Payer Coverage | Comments Off on GIRS Tracks Impact of Health Insurer Mergers on Patient Access to your Medical Technologies

Global Integrated Reimbursement Services, Inc. (GIRS) tracks major insurer mergers including the Anthem and Cigna Corp mergers that was blocked by the U.S. Department of Justice. See our LinkedIn Page for more details. However, insurers are now also considering merging with healthcare delivery systems. One such case of a merger that we are tracking is that of Ardent Health Services (“Ardent”) and LHP Hospital Group, Inc. (“LHP”). The companies jointly announced on Wednesday, October 5th, 2016 that they have...

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GIRS Educates Clients about Coding Changes and Reimbursement for Pneumatic Compression Devices

Posted by on Oct 7, 2016 in Coding & Billing | Comments Off on GIRS Educates Clients about Coding Changes and Reimbursement for Pneumatic Compression Devices

The original article “Correct Coding for Pneumatic Compression Devices” was published in August 2010. The Durable Medical Equipment Pricing Data Analysis and Coding (PDAC) contractor announced today that this article was revised recently. This revision provides additional information regarding the HCPCS coding requirements for PCDs and related appliances. It also emphasizes that the only products that may be billed to the DME MACs using codes E0650, E0651, E0652, and E0675 are those for which the PDAC has completed a...

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GIRS Successfully Supports Client and their Accounts to Avoid the Top 10 Errors In Medicare Part B Claims Submissions

Posted by on Oct 7, 2016 in Hotline Successes | Comments Off on GIRS Successfully Supports Client and their Accounts to Avoid the Top 10 Errors In Medicare Part B Claims Submissions

Novitas Medicare Part B, the Medicare JL contractor for providers in the District of Columbia, Delaware, Maryland, New Jersey and Pennsylvania posted the most common reasons for Part B claim submission errors for September 2016. Some key reasons and how GIRS assists our clients’ accounts to avoid these errors are presented below: Non-covered charges. Duplicate claim service The benefit for this service is included in the payment or allowance for another service or procedure that has already been adjudicated...

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