Keeping your office up-to-date on industry and insurance changes, late-breaking billing & reimbursement news, and general inter-office communication...


Medicare is taking steps to remove Social Security numbers from Medicare cards. Through this initiative the Centers for Medicare & Medicaid Services (CMS) will prevent fraud, fight identity theft and protect essential program funding and the private healthcare and financial information of our Medicare beneficiaries.

CMS will issue new Medicare cards with a new unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI) to replace the existing Social Security-based Health Insurance Claim Number (HICN) both on the cards and in various CMS systems we use now. We’ll start mailing new cards to people with Medicare benefits in April 2018. All Medicare cards will be replaced by April 2019.

Based on feedback from healthcare providers, practice managers and other stakeholders, CMS is developing capabilities where doctors and other healthcare providers will be able to look up the new MBI through a secure tool at the point of service. To make this change easier for you and your business operations, there is a 21-month transition period where all healthcare providers will be able to use either the MBI or the HICN for billing purposes.

Therefore, even though your systems will need to be able to accept the new MBI format by April 2018, you can continue to bill and file healthcare claims using a patient’s HICN during the transition period. Beginning in April 2018, Medicare patients will come to your office with new cards in hand. We’re committed to giving you information you need to help your office get ready for new Medicare cards and MBIs.

Here are 3 steps you can take today to help your office or healthcare facility get ready:

  1. Verify all of your Medicare patients’ addresses. If the addresses you have on file are different than the Medicare address you get on electronic eligibility transactions, ask your patients to contact Social Security and update their Medicare records.
  2. Work with us to help your Medicare patients adjust to their new Medicare card. When available later this fall, you can display helpful information about the new Medicare cards. Hang posters about the change in your offices to help us spread the word.
  3. Test your system changes and work with your billing office staff to be sure your office is ready to use the new MBI format.

For more information please visit:


Senior administrative officials met Friday to discuss an executive order on the cost of pharmaceuticals, a roundtable informed by Trump’s “Drug Pricing and Innovation Working Group.” Kaiser Health News examined documents that shed light on the workings of this working group.

The documents reveal behind-the-scenes discussions influenced by the pharmaceutical industry. Joe Grogan, associate director of health programs for the Office of Management and Budget (OMB), has led the group. Until March, Grogan served as a lobbyist for Gilead Sciences, the pharmaceutical company that priced its hepatitis C drugs at $1,000 per pill.

To solve the crisis of high drug prices, the group discussed strengthening the monopoly rights of pharmaceuticals overseas, ending discounts for low-income hospitals and accelerating drug approvals by the Food and Drug Administration. The White House declined to comment on the working group.

According to the documents — the latest of which is dated June 1— the working group focused on the following “principles” and “talking points”:

1. Extending the patent life of drugs in foreign markets to “provide for protection and enforcement of intellectual property rights.” This will ensure “that American consumers do not unfairly subsidize research and development for people throughout the globe.”

2. Promoting competition in the U.S. drug market — both by “modernizing our regulatory and reimbursement systems” and limiting “barrier to entry, including the cost of research and development,” according to the documents.

3. Value-based pricing, when pharmaceutical companies keep the list prices of drugs unchanged but offer rebates if patients don’t improve. It’s unclear who would audit the effectiveness of the drugs, what criteria they would use to evaluate them and who would receive the rebates.

4. Grogan invited Robert Shapiro — an adviser for Gilead and former secretary of Commerce under President Bill Clinton — to brief the working group on value-based pricing on May 18.

Grogan and Shapiro also discussed issuing 10-year U.S. Treasury bonds to drug manufacturers to pay for expensive, hepatitis C drugs like Sovaldi and Harvoni under Medicare and Medicaid, to avoid rationing drugs to the sickest patients.

After the working group’s first meeting on May 4, Grogan distributed detailed policy recommendations on expediting generic drug approvals, creating a new tax credit “of up to 50 percent” for investments in generic drug manufacturing, distribution and research and development. The documents also propose scaling back the 340B program, which requires drug manufacturers to provide some medicines at a discount to hospitals that treat low-income patients.

For the full article please visit:


Cleveland Clinic is venturing into the health insurance business for the first time with Oscar Health. The organizations announced this week they will offer co-branded health insurance plans to consumers in northeast Ohio, marking Cleveland Clinic's first entrée into the payer market with a product bearing its name. The health plans are expected to be sold on the Ohio health insurance exchange as well as off the exchange starting in 2018. Cleveland Clinic will continue to work collaboratively with other health insurers.

Oscar Health was launched in 2012 as Oscar Insurance Corp. by Josh Kushner, the younger brother of Jared Kushner and two Harvard Business School classmates, Kevin Nazemi and Mario Schlosser, according to Bloomberg Businessweek.

Cleveland Clinic Chief of Staff Brian Donley, MD said by statement that the relationship with Oscar Health goes beyond the traditional approach of care. Patients will have the option of a virtual visit, at no co-pay. This will avoid unnecessary trips to the doctor or a stay in the hospital whenever possible. Cleveland Clinic's express care online and Oscar's virtual visits will use smartphone technology to analyze health needs and help members understand their care options and costs.

Cleveland Clinic and Oscar Health will integrate their clinical and consumer care approaches. Every member will be matched with a Cleveland Clinic care team comprised of a primary care provider, physician assistants and other allied health professionals, and an Oscar Health concierge team made up of a nurse and three care guides.

"Together, Cleveland Clinic and Oscar Health intend to offer a different approach, one that breaks down the complexities between providers and insurers, allowing our patients to easily navigate the healthcare and health insurance systems, get the highest quality care at a reasonable price, and improve their overall health," said Cleveland Clinic CFO Steve Glass.

The collaboration is slated to begin this fall. Consumers in five northeast Ohio counties – Cuyahoga, Summit, Lorain, Medina and Lake – will be able to purchase Cleveland Clinic | Oscar individual health plans.

"By linking Oscar's member engagement platform to a world-renowned, physician-led health system like the Cleveland Clinic, we can align incentives and focus on the things that matter most: keeping members healthy; making it as easy as possible for them to find care when they need it, in the right clinical setting; and driving healthcare costs down," said cofounder Schlosser, who is Oscar Health's CEO.

"Cleveland Clinic's guiding principle of 'Patients First' shapes everything we do, including our relationships with insurers, which is why we look for insurance plans with innovative, patient-centered policies," Glass said.

For more information please see:


Since the implementation of ICD-10, SummaCare has not denied claims based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the correct family.

Effective June 1, 2017, SummaCare will begin rejecting claims that are not coded to the highest level of specificity. The ICD-10 code set allows clinicians to more precisely describe diseases and conditions than they could before.

Beginning June 1, 2017, SummaCare will begin rejecting professional charges that are submitted via EDI without the service location (location where services were rendered). The service location must be submitted in Loop 2310C along with the following required segments: NM1 (Service facility location name), N3 (address), N4 (city, state and zip code).

Claims submitted with the following location codes, will be excluded from receiving this edit: 03 – School, 11 – Office, 12 – Home, 20 – Urgent Care Facility, 42 – Ambulance Air or Water, 41 – Ambulance – Land, 49 – Independent Clinic, 50 – Federally Qualified Health Center, 60 – Mass Immunization Center, 65 - End-Stage Renal Disease Treatment Facility, 71 – Public Health Clinic, 72 – Rural Health Clinic, 81 – Independent Laboratory.

Please Note: this edit is not based on the date of service, but is based on the date the claim is submitted.

For any questions please contact SummaCare Provider Support at or call 330-996- 8400.


Hospital IT professionals are increasingly tinkering with voice technology apps like Amazon Alexa to deliver routine medical information and help ease clinicians' safety concerns in the operating room, according to a CNBC report.

Experts suggest there is a plethora of opportunities for voice technology. For example, physicians could use Alexa and similar apps to transcribe notes and document patient interactions, allowing them to spend more quality time with patients instead of with EHRs.

Clinicians at Boston Children's Hospital recently released KidsMD, an Alexa-like app designed to provide users with health information about common illnesses and medication dosing. The hospital is also piloting an Alexa app to help physicians follow surgery protocols and procedures while in the OR, according to the report.

Amazon officials also recognized Alexa's affect on healthcare delivery. To spur innovation, the company recently partnered with Merck to encourage developers to build apps to help diabetes patients manage their health. However, some clinicians are dubious of incorporating Alexa into the workforce because the system is not HIPAA-compliant and cannot safely store patients' health information, according to the report.


During its annual meeting this week, the American Medical Association adopted policy measures that aim to fight physician burnout, according to AMA Wire.

The policy encourages more research into how to properly identify risk factors for depression and burnout and asks medical schools to collect data from students willing to share details about their mental health. It also asks state medical boards to prioritize mental health evaluations over those for physical health on licensing applications, and calls for greater public attention on mental health issues to help destigmatize them within the medical community.

“Today’s policy builds on the AMA’s current efforts to prevent physician burnout and improve wellness," said Omar Z. Maniya, MD, a member of the AMA Board of Trustees. "We are committed to supporting physicians throughout their career journey to ensure they have more meaningful and rewarding professional experiences and provide the best possible care to their patients.”


The Zika virus roared onto the scene last year as the scourge of the summer, but it’s slinking off the radar as 2017 dawns, having left far less devastation in the U.S. than analysts had warned.

Worldwide, the situation is still dire. Thousands of babies have been born with Zika-related defects in Latin America, though only a few dozen babies have been born with defects in the U.S. Those are chiefly cases in which the mothers or their partners are infected while traveling.

Mosquitoes did infect about 220 people in pockets of Florida and Texas, though Florida now reports its neighborhoods are clean. Texas officials reported a sixth case in Brownsville, near the Mexican border, on Dec. 22, prompting efforts to stamp out further transmission.

Researchers predict a repeat this summer. After years of obscurity in African forests and Oceania, they say, the virus has established itself in the Western Hemisphere.

“I think the bottom line is that Zika is likely to continue to spread in Latin America, the Caribbean and elsewhere in the world for many years, so we need to anticipate that there will be a steady stream of travelers returning with Zika and that we will continue to have the risk of clusters as we had in Miami and Brownsville this year,” said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention.

For more information on this story please visit the following:


Hospitals across the nation are exploring ways to capture more revenue to succeed in the current challenging economic environment.

Medical bills can be confusing, overwhelming
1. About 20 percent of insured Americans ages 18 to 64 reported struggling to pay medical bills in the past year.

2. Fifty-three percent of Americans believe receiving a large, unaffordable medical bill is as bad as being diagnosed with a serious illness, while 10 percent of Americans believe a large bill is worse.

3. The number of people struggling to pay their medical bills is shrinking.

4. Medical bills confuse most patients.

5. Patients said they most often received medical bills in the mail (43.8 percent) or at the point of service (30 percent) and less frequently through email (17.4 percent) or a patient portal (6.6 percent), according to the Mad*Pow report.

States are taking action on balance billing
6. Out-of-network physicians, not bound by in-network rate agreements, may bill patients for the remaining balance. This practice leads to patients receiving surprise medical bills.

7. Many patients receive surprise out-of-network bills for a visit to an in-network hospital's emergency room, according to research published in The New England Journal of Medicinein November.

8. In March, the American College of Emergency Physicians responded to the study published in the NEJM, saying it "fails to provide a fair assessment of so-called surprise billing in emergency care."

9. Federal law does not protect consumers from balance billing. About one-fourth of all states have policies to address at least some of the scenarios that typically result in unexpected charges.

10. Legislators from seven states proposed legislation in the first few months of 2017 to mitigate the practice of surprise medical billing.

11. Thirty-seven percent of Americans said they could not pay for an unexpected medical bill that exceeded $100 without going into debt, and only 23 percent would be able to cover an unexpected medical bill of more than $2,000, according to the Amino & Ipsos report.

Hospitals and physician groups are outsourcing billing
12. The U.S. market for physician and ambulatory revenue cycle management outsourcing is expected to increase by 42 percent from the fourth quarter of 2016 to the first quarter of 2019.

13. A December 2016 Black Book survey, which included responses from 1,309 hospital CFOs and business office leaders, revealed 39.8 percent of U.S. hospitals outsourced complex claims to a specialized vendor in the third quarter of 2016. That's up from 20.4 percent of hospitals in 2013.

14. Many hospitals hope outsourcing will reduce write-offs and give their organizations a financial boost. According to the December Black Book survey, 49 percent of hospital CFOs said outsourcing, including offshoring, is becoming a more viable alternative in 2017 for more parts of their organizational claim processing.

15. Black Book projects the market for outsourced revenue cycle management will grow at a compound annual growth rate of 26.5 percent over the next two years, with the market reaching a value of $9.7 billion by 2018.

For the full story please see:

Please subscribe to our Newsletter & share with others who would enjoy it as well.
View this email in your browser
You are receiving this email because of your relationship with NCDS. Please reconfirm your interest in receiving emails from us. If you do not wish to receive any more emails, you can unsubscribe here.

7550 Lucerne Dr STE 405, Middleburg HTS, OH, 44130

Update Profile/Email Address | Forward Email
Text block at your service. Replace this text with yours.