Tagged with Compliance
On October 9, the Department of Health and Human Services (HHS) announced proposed changes that seek to modernize and clarify the regulations that interpret the Physician Self-Referral Law (the Stark Law) and the Federal Anti-Kickback Statute. The proposed rule has been designed to provide greater certainty for healthcare providers participating in value-based arrangements and providing coordinated care for patients. The proposed changes are intended to ease the compliance burden for healthcare providers across the industry while maintaining strong safeguards to protect patients and programs from fraud and abuse.
AdvantEdge Healthcare Solutions is a national top 10 medical billing company that is a leading vendor to pathology practices across the country for billing, coding, and revenue cycle management services since 1967. If you have questions about how AdvantEdge can improve your pathology practice billing and coding so that you are collecting every dollar that…
On June 20, CMS released a renewed guidance to state Medicaid agencies that outlines the necessary assurances that states should make to ensure that program resources are reserved for those who meet eligibility requirements.
CMS has announced the release of a final rule designed to “update and modernize” the Programs of All-Inclusive Care for the Elderly (PACE) program, based upon best practices in caring for frail and elderly individuals.
Effective June 1, more network care providers will be required to obtain consent from UnitedHealthcare or UnitedHealthcare Oxford members before referring them to or using out-of-network laboratories and pathologists for their care.
The FDA has published two new guidance documents designed to align the agency’s requirements for x-ray imaging devices with various international standards.
CMS proposed a rule that would give the agency earlier notice of a potential sale or merger of an accrediting organization such as the Joint Commission.
The Governor of New Jersey has signed legislation that will enhance enforcement of mental health parity laws in the state. The law aims to improve transparency and accountability by requiring insurers to provide coverage consistent with federal requirements of the Mental Health Parity Act of 2008.
CMS has released a reminder regarding correct billing for recalled cardiac medical in compliance with Medicare requirements for reporting manufacturer credits.
Last month, CMS released a proposed rule to remove some of the Medicare participation requirements currently in place for health care facilities. According to the press release, the agency estimates that policies from the proposed rule could potential save hospitals and other facilities approximately $1.12 billion annually.
October 2018 ~ The New Jersey Department of Human Services, Division of Medical Assistance and Health Services (DMAHS) issued a newsletter to NJ FamilyCare (NJFC) providers to clarify the requirements for the provision and billing of NJFC services via telehealth and telemedicine. The guidance comes as a follow-up to the New Jersey Telemedicine and Telehealth…
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.