Managed Care

It is to manage costs, use, and quality of the health care system. All HMOs and PPOs, and many fee-for-service plans, have managed care. 

HMO (Health Maintenance Organization)

It is prepaid health plans. You needs to pay a monthly premium and it covers your doctors' visits, hospital stays, emergency care, surgery, checkups, lab tests, x-rays, and therapy. You should use the doctors and hospitals designated by the HMO plan

Deductible

The premium amount must pay each year by patient to cover the medical care expenses before insurance policy starts effective. 

Copayment

It is another way of sharing medical costs by patient. Patient needs to pay a flat fee to doctor for every time they receive a medical service(for example, $10 for every visit to the doctor). It is fixed by Insurance company

Coinsurance

The amount you are required to pay for medical care in a fee-for-service plan after you have met your deductible. The coinsurance rate is usually expressed as a percentage. For example, if the insurance company pays 80 percent of the claim, you pay 20 percent. 

2011 CPT changes in Interventional cardiology

1. 93451 - RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT
2. 93452 - L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I
3. 93453 - R & L HRT CATH W/NJX L VENTRICULOG IMG S&I
4. 93454 - CATH PLMT & NJX CORONARY ART ANGIO IMG S&I
5. 93455 - CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I
6. 93456 - CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I
7. 93457 - CATH PLMT R HRT/ARTS/GRFTS W/NJX&ANGIO IMG S&I
8. 93458 - CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I
9. 93459 - CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I
10. 93460 - R & L HRT CATH WINJX HRT ART& L VENTR IMG S&I
11. 93461 - R&L HRT CATH W/INJEC HRT ART/GRFT&L VENT IMG S&I
12. 93462 - LEFT HEART CATH BY TRANSEPTAL PUNCTURE
13. 93463 - MEDICATION ADMIN & HEMODYNAMIC MEASURMENT
14. 93464 - PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASURE
15. 93563 - NJX SEL HRT ART CONGENITAL HRT CATH W/S&I
16. 93564 - NJX SEL HRT ART/GRFT CONGENITAL HRT CATH W/S&I
17. 93565 - NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I
18. 93566 - NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I
19. 93567 - NJX SUPRAVALV AORTOG HRT CATH W/S&I
20. 93568 - NJX PULMONARY ANGIO HRT CATH W/S&I
21. 95800 - SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME
22. 95801 - SLP STDY UNATND W/MIN HRT RATE/O2 SAT/RESP ANAL
23. 96446 - CHEMOTX ADMN PRTL CAVITY PORT/CATH

PECOS

Provider Enrollment, Chain, and Ownership System (PECOS)

Providers and suppliers must have Internet Explorer version 5.5 or higher and have the most recent version of Adobe Acrobat Reader before initiating an enrollment action using Internet-based PECOS.

The Internet-based Provider Enrollment, Chain and Ownership System (Internet-based PECOS) can be used in lieu of the Medicare enrollment application (i.e., paper CMS-855) to:

• Submit an initial Medicare enrollment application
• View or change your enrollment information
• Track your enrollment application through the web submission process
• Add or change a reassignment of benefits
• Submit changes to existing Medicare enrollment information
• Reactivate an existing enrollment record
• Withdraw from the Medicare Program

Advantages of Internet-based PECOS

• Faster than paper-based enrollment (45 day processing time in most cases, vs. 60 days for paper)
• Tailored application process means you only supply information relevant to YOUR application
• Gives you more control over your enrollment information, including reassignments
• Easy to check and update your information for accuracy
• Less staff time and administrative costs to complete and submit enrollment to Medicare

Using Internet-based PECOS Is Easy!

Before initiating an enrollment action using Internet-based PECOS, you should review the applicable "Basics of Internet-based Provider Enrollment, Chain and Ownership System (PECOS)" Fact Sheet(s) listed in the Downloads and Links section below.

Individual Physicians and Non-Physician Practitioners

Physicians and non-physician practitioners may access Internet-based PECOS by using the User IDs and passwords that they established when they applied on-line to the National Plan and Provider Enumeration System (NPPES) for their National Provider Identifiers (NPIs). If they did not establish User IDs and passwords at that time (for example, they may have submitted paper NPI applications to the NPI Enumerator and had no reason to establish User IDs and passwords), they may do so now by going to the NPPES hyperlink listed below and following the directions on the screens. If they have forgotten their User IDs or passwords, or otherwise need assistance in this regard, they may contact the NPI Enumerator at 1-800-465-3203 or customerservice@npienumerator.com.

1. Log onto Internet-based PECOS with your NPPES User ID and password.
Click on "PECOS" in the "Related Links Outside CMS" section below.

2. Complete, review, and submit an electronic enrollment application.
Internet-based PECOS will walk you through the application process and supply you with a 2-page Certification Statement for each enrollment application you submit.

3. Mail the original signed Certification Statement from Internet-based PECOS and supporting documents to the Medicare contractor within 7 days of your electronic submission.
The effective date of filing an enrollment application is the date the Medicare contractor receives the signed and dated (blue ink recommended) Certification Statement. Note: A Medicare contractor will not process an Internet enrollment application without the signed and dated 

Certification Statement.

Organizational Providers and Suppliers 

Obtaining access to Internet-based PECOS by organizational providers and suppliers (e.g., professional associations, professional corporations, limited liability corporations) involves several steps, and the first step must be taken by the Authorized Official (AO) of the DMEPOS supplier.