Tagged with Compliance
UnitedHealthcare (UHC) released a policy revision for molecular and genetic tests that have proven efficacy in the diagnosis or treatment of medical conditions.
As of July 1, Anthem Blue Cross and Blue Shield of Wisconsin (BCBSWI) will require unspecified diagnosis codes to only be used when an established diagnosis code does not exist to describe the diagnosis. Reimbursement will be based on review of the unspecified diagnosis code on an individual claim basis.
New Jersey Medicaid has announced changes to the state’s NCPDP D.0/1.2 Payer Sheet, intended to enhance the State’s compliance with the National Council for Prescription Drug Program (NCPDP) D.0 standard.
The New Hampshire House Health and Human Services Committee and Senate have passed legislation to reauthorize the state’s Medicaid expansion program for an additional five years, as well as add work requirements, and will also transition beneficiaries from the individual insurance exchange into a managed care model.
Connecticut lawmakers have introduced a bill that would implement work or volunteer requirements for adult Medicaid recipients and prohibit the Department of Social Services (DSS) from removing work requirements for Supplemental Nutrition Assistance Program (SNAP) recipients.
The New Jersey Department of Health is seeking to further expand inpatient treatment capacity for individuals battling mental health issues and drug addiction and has invited providers across the state to submit plans to add up to 53 more inpatient beds in the underserved regions of the state.
CMS has released Part One of the 2019 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part D Payment Policies, containing proposed changes to the Part C Risk Adjustment Model and the use of encounter data.
CMS, on December 28th, issued a Survey and Certification Memorandum (S&C Memo) to state survey agencies to clarify and reinforce its position that it prohibits physicians and health care providers from texting orders.
Cigna has implemented an integrated oncology management program which requires providers to precertify certain medical oncology medications through a national ancillary provider (instead of Cigna), including primary chemotherapy, and supportive drugs, such as medical injectables and infusions.
CMS has submitted a proposed rule that, if finalized, would revise the Medicare Advantage program (Part C) regulations and Prescription Drug Benefit program (Part D) regulations to implement certain provisions of the Comprehensive Addiction and Recovery Act (CARA) and the 21st Century Cures Act.
CMS Reinforces Rule Prohibiting Billing Dually Eligible Individuals Enrolled in Qualified Medicare Beneficiary Program
CMS has issued a notice to reinforce the rule that Medicare providers and suppliers should not bill beneficiaries enrolled in the Qualified Medicare Beneficiary (QMB) program for Medicare cost-sharing.
Effective for dates of service beginning January 1, 2018, Harvard Pilgrim will cover 3D mammography (digital breast tomosynthesis (DBT)) for screening or diagnostic purposes for members of its Connecticut plans.
The New Jersey Department of Human Services (DHS) last month announced that it has expanded the list of covered health benefits available to align behavioral health coverage for Medicaid Long Term Services and Supports (MLTSS), Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs), and Division of Developmentally Disabled (DDD) MCO members participating in the New Jersey FamilyCare (NJFC) Medicaid managed care program.
CMS has lifted enrollment and marketing sanctions against Cigna for its Medicare Advantage and prescription drug plans.
The Texas House of Representatives has passed a bill, by unanimous vote, that will enable physicians licensed in the state to supply telemedicine services to patients they have never met in person.
CMS has released guidance stating that it will no longer require U.S. residents enrolling in exchange plans via a direct enrollment pathway to complete the enrollment process on HealthCare.gov.
CMS issued an Informational Bulletin providing additional clarity on provisions of the final regulation defining home and community-based service (HCBS) settings. The bulletin indicates that that states may take an additional three years to ensure compliance with criteria of a HCBS setting. The agency says this additional time “will be helpful to states to ensure compliance activities are collaborative, transparent and timely.”
CMS has sent over 800,000 letters to clinicians, with notification that they will not be evaluated under the MACRA Merit-based Incentive Payment System (MIPS) in 2017. Federal officials predict only about one-third of clinicians will have to file quality reports this year under the new Medicare payment system.
CMS’ newly released fact sheet explains how Administrative Simplification standards streamline day-to-day tasks such as billing, verifying patient eligibility, sending and receiving payment.
In a letter to CMS and the Office of the National Coordinator for Health Information Technology, MGMA, along with 100 medical organizations, requested a deferment for the required use of 2015 Edition CEHRT in the QPP or Medicaid MU Program. The letter recommends that use of 2015 CEHRT remain voluntary until such technology is widely available, no sooner than January 2019.