Changes to billing for office-based procedures

Effective April 1, 2011, Priority Health is implementing the Michigan Quality Improvement Consortium (MQIC) guideline for office-based surgery requiring moderate or higher levels of sedation.  After this date, physician practices may bill Priority Health for these procedures only if the practice or the anesthesia group administering the sedation has already received, or applied for, the required accreditation.  The practice or anesthesia group must also have received accreditation, or have completed the accreditation process and be awaiting accreditation, no later than Dec. 31, 2011.  Priority Health may recover payment for any services not meeting the guideline. The MQIC guideline can be found at mqic.org.

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