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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

CMS Delays the Inclusion of U.S. Territories Under MDRP Until 2020

Posted by on Dec 9, 2016 in Future Trends, Payer Coverage | Comments Off on CMS Delays the Inclusion of U.S. Territories Under MDRP Until 2020

The Center for Medicare and Medicaid Services (CMS) released an interim final rule (IFR), Medicaid Program; Covered Outpatient Drugs; Final Rule. The Rule delays the expansion of the Medicaid Drug Rebate Program (MDRP) to Puerto Rico and the U.S. Territories (collectively, “Territories”) for three years, until April 1, 2020. The inclusion of U.S. Territories under the MDRP has been delayed to account for the need for more time and the complexity of the transition for both the Territories and...

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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...

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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...

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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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