Category Archives: Medical Blog

Surprise bills or Inadequate Network?

Posted May 20, 2019 Health plans hold all the cards when negotiating with providers (reimbursement) and patients (health insurance rates). Recent attempts by health plans to consolidate have made that abundantly clear, and litigation to stop these mergers has tried to prevent a bad situation from becoming worse. In response, health plans have narrowed their provider networks, offering fewer choices to patients and far less reimbursement to providers. Physicians only recourse in these blatantly unbalanced contract negotiations is to say

Key Updates for Medicaid Beneficiaries

Posted May 7, 2019 “The following is a message from the Cabinet for Health and Family Services” Due to the legal decision on March 27, 2019, the Kentucky HEALTH program did not begin on April 1, 2019, and there were no changes in coverage or benefits for any Medicaid beneficiaries. Beneficiaries and their eligible family members can continue to access Medicaid-approved healthcare services, as well as vision, dental, and non-emergency medical transportation. Check out the Kentucky HEALTH Program Update and

President’s Message: A Tragic Ending

Posted April 25, 2019 During his testimony before the Kentucky Legislature a few weeks ago, Dr. Mike Kalfas, a family medicine physician, recalled seeing a young man on a Friday afternoon who was suffering from opioid addiction and writing a prescription for buprenorphine to help block the opioid cravings of his patient. After his office closed, the insurance company denied the medication because it required prior authorization. When Dr. Kalfas returned to his office on Monday morning, he learned that

CHFS Statement on Kentucky HEALTH Ruling

Posted March 29, 2019 Press release issued by the Commonwealth of Kentucky Cabinet for Health and Family Services Contact: Beth Fisher (502) 564-7042, ext. 3101 CHFS Statement on Kentucky HEALTH Ruling FRANKFORT, Ky. (March 27, 2019) – Secretary Adam Meier of the Cabinet for Health and Family Services (CHFS) released the following statement regarding the Commonwealth’s Section 1115 Medicaid waiver, known as Kentucky HEALTH: “The judge illogically concluded that Medicaid is all about paying for healthcare for as many people as

Kentucky Office of Rural Health to host annual Kentucky Telehealth Summit on May 23

Posted March 27, 2019 The Kentucky Office of Rural Health will host its third annual Kentucky Telehealth Summit on Thursday, May 23 at the Knicely Conference Center at Western Kentucky University in Bowling Green. The one-day event, which is intended for anyone interested in or currently practicing telehealth, will run from 8 a.m. to 3:30 p.m. Six plenary sessions are scheduled for the morning and early afternoon followed by two breakout sessions. Emily Wein, a health care lawyer at Foley

Déjà vu All Over Again

Posted March 20, 2019 You might recall that last year Anthem announced their intention to reduce payment for office visits (E&M services) performed on the same day as an office diagnostic or therapeutic procedure (billed using the CPT modifier 25) by 50%. The Kentucky Medical Association, together with the American Medical Association, the Greater Louisville Medical Society and several national specialty societies were able to convince Anthem to withdrawal their ill-conceived policy. This policy, which ignored established CPT rules, not

KMA Sends Letter to Anthem Regarding Modifier 25 Change

KMA President Bruce Scott, MD sent a letter to Anthem Health Plans of Kentucky President Kennan Wethington regarding a recent change in coding policy announced by Anthem concerning the use of Modifier 25. The new policy, published in the February 2019 Anthem Kentucky Provider Newsletter, says Anthem will deny an E/M service with a modifier 25 billed on the day of a related procedure, when there is a recent service or procedure for the same or similar diagnosis on record.

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