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House Bill to Repeal SGR Physician Payment Formula Also Addresses Telehealth

Fri, 04/10/2015 - 18:58
The nearly $200 billion Medicare legislation to repeal the Sustainable Growth Rate (SGR) physician payment formula includes several other significant provisions, among them three that address telehealth. The House of Representatives passed the bill on March 26 by an overwhelming majority and sent it to the Senate, where it will be addressed following Congress's return from their spring recess on Monday, April 13. To learn more about the telehealth provisions in this bill, please click here for a summary in the National Law Review.

NCQA Seeks Public Comments on Changes to Its Health Plan Accreditation by APRIL 8

Thu, 03/12/2015 - 18:57
NCQA is asking for interested parties to submit comments regarding proposed changes to its Health Plan Accreditation (HPA) by 5:00 PM EST on Wednesday, April 8, 2015.

From NCQA:

"NCQA is releasing proposed changes to Health Plan Accreditation for public comment, including:

  • Developing a more comprehensive assessment of network adequacy and provider directory accuracy by updating existing requirements and adding new requirements in a new category of standards: Network Management. 
  • Including new requirements to strengthen NCQA’s ability to detect systematic issues related to Utilization Management. 
  • Simplifying scoring for file review elements in HPA and other accreditation/certification products that contain these elements. 

In addition to HPA standards updates, NCQA proposes policy changes to the following programs:

  • Managed Behavioral Healthcare Organization Accreditation (MBHO) 
  • Wellness and Health Promotion Accreditation (WHP) 
  • Credentials Verification Organization Certification (CVO) 
  • Health Information Products Certification (HIP) 
  • Utilization Management and Credentialing Certification (UM/CR)" 

Please click HERE for more information on the proposed changes and instructions for submitting comments.

CAQH Announces Updates: UPD to CAQH ProView™ Transition

Wed, 03/11/2015 - 03:49
From CAQH:

CAQH ProView, the next generation of the Universal Provider Datasource® (UPD), recently launched on March 2, 2015. Several resources are available to help you in the transition:

The CAQH ProView User Guides are now available
The links below provide access to each document:
  1. Providers - CAQH ProView Provider User Guide
  2. Practice Managers - CAQH ProView Practice Manager Module User Guide
  3. Participating Organizations - CAQH Proview Participating Organization User Guide
Save the Date for CAQH ProView Training
CAQH will provide online training via webinars for participating organizations throughout March. Click here to view the available dates and to register for a session.

A complete list of action items, including information for you to communicate to your providers and IT department is available on the CAQH website.

Request Roster Validation Tool and View Sample Roster Files
CAQH has developed a roster validation tool for your organization to confirm that your new roster file format meets the CAQH ProView required changes. Sample CAQH roster file now available: Please email to request the tool and to access the sample roster files.

Need More Information? 
CAQH ProView - Frequently Asked Questions is the place to find updated answers to questions about how to prepare for the launch of CAQH ProView and information about the solution's features. If you do not see an answer to your question, please email

All Healthcare Industry Eyes on the Supreme Court This Week

Mon, 03/02/2015 - 19:49
Beginning on March 4, the U.S. Supreme Court will hear the first oral arguments in King v. Burwell, the case that will determine the validity of federal subsidies assisting millions of American patients afford health insurance under the Affordable Care Act. Should the Court strike down these subsidies, the effects will be felt across the entire healthcare industry. Here are "5 Things to Know About the Supreme Court Case Challenging the Health Law," a report by Kaiser Health News.

NAMSS Offering Live Education in Atlanta

Mon, 02/16/2015 - 23:16
The National Association Medical Staff Services is hosting its annual Regional Education Summit, providing MSPs with three live learning opportunities in Atlanta, GA on March 13-14. Whether you are preparing for a NAMSS Certification Exam, are new to the industry, or have new staff that need critical introductory education, the NAMSS Regional Education Summit provides an unparalleled opportunity to learn and network. Join NAMSS at the Westin Peachtree Plaza and connect with fellow industry professionals at one of the following three courses:

  • The two-day NAMSS Credentialing Specialist (CPCS) Certification Preparation Course helps those preparing to take the CPCS certification exam gain a sense of what topics the exam focuses on and develop a personalized study strategy. REGISTER NOW
  • The two-day NAMSS Medical Services Management (CPMSM) Certification Preparation Course helps those preparing to take the CPMSM certification exam gain a sense of what topics the exam focuses on and develop a personalized study strategy. REGISTER NOW
  • Credentialing 101 is a two-day program that introduces attendees to credentialing and gives examples of how and when to apply accreditation standards. REGISTER NOW
Register Now and Save! Enter the following code during checkout and save 10% off of meeting registration: NAMSS10GA. Questions? Contact the NAMSS Executive Office at

ABIM President Announces Changes to MOC Program

Mon, 02/09/2015 - 22:46
On February 3, 2015, the American Board of Internal Medicine (ABIM) announced that it would be making significant changes to its Maintenance of Certification (MOC) program via a letter distributed by ABIM President and CEO Richard Baron, MD. Dr. Baron began the letter by stating, " ABIM clearly got it wrong. We launched programs that weren't ready and and we didn't deliver an MOC program that physicians found meaningful. We want to change that." For a full version of the letter, please click here.

NBPAS Provides New Recertification Alternative

Mon, 01/26/2015 - 21:33

According to a report by MedPage Today, the National Board of Physicians and Surgeons (NBPAS) has been established to provide physicians with an alternative path to board recertification. Founded by vocal critics of maintenance of certification, such as Paul Teirstein, MD of the Scripps Clinic in San Diego, CA, the NBPAS presents new competition for the American Board of Medical Specialties (ABMS) in the board recertification process.

From the NBPAS website:

"The National Board of Physicians and Surgeons (NBPAS) is committed to providing certification that ensures physician compliance with national standards and promotes lifelong learning. We require fulfillment of the following criteria for board certification:

  •  Candidates must have been previously certified by an American Board of Medical Specialties member board. Initially, NBPAS will only certify physicians in selected specialties.  Other specialties and other boards will follow.
  • Candidates must have a valid, unrestricted license to practice medicine in at least one US state.
  • Candidates must have completed a minimum of 50 hours of continuing medical education (CME) within the past 24 months, provided by a recognized provider of the Accreditation Council for Continuing Medical Education (ACCME). CME must be related to one or more of the specialties in which the candidate is applying. Re-entry for physicians with lapsed certification requires 100 hours of CME with the past 24 months.
  • For some specialties (ie interventional cardiology, electrophysiology, critical care), candidates must have active privileges to practice that specialty in at least one  US hospital licensed by a nationally recognized credentialing organization with deeming authority from CMS (ie JCHAO, HFAP, DNV).
  • A candidate who has had their medical staff appointment/membership or clinical privileges in the specialty for which they are seeking certification involuntarily revoked and not reinstated, must have subsequently maintained medical staff appointment/membership or clinical privileges for at least 24 months in another US hospital licensed by a nationally recognized credentialing organization with deeming authority from CMS (ie JCHAO, HFAP, DNV)."

For the full report from MedPage Today, please click here.