Tagged with Compliance
UHC Participating Provider Laboratory and Pathology Protocol Update
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.
FDA Shares Two Guidance Documents for Imaging Providers
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 Seeks Notice of Ownership Changes at Accreditation Organizations
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.
New Jersey – Mental Health Parity Legislation Signed Into Law
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 Medicare Billing Reminder for Cardiac Device Credits
CMS has released a reminder regarding correct billing for recalled cardiac medical in compliance with Medicare requirements for reporting manufacturer credits.
CMS Proposes to Lift Regulations, Ease Provider Burden
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.
New Jersey Medicaid Issues Telehealth Coverage and Reimbursement Guidance
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…
New Hampshire House and Senate Approve Medicaid Expansion Bill
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 Considers Work Requirement Bill for Certain Medicaid Enrollees
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.
New Jersey Seeks Inpatient Capacity Expansion for Mental Health and Substance Use
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 2019 Medicare Advantage Part I Advance Notice Released
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 Issues Clarification around Texting Patient Orders
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 Requirement to Precertify Oncology Medications
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.
Medicare Advantage Policy and Technical Changes for Contract Year 2019
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.
Harvard Pilgrim CT Policy Updates for 3D Mammography Coverage
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.
NJ – DHS Expands Behavioral Health Benefits Covered Under NJ FamilyCare
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 Removes Medicare Advantage Sanctions on Cigna
CMS has lifted enrollment and marketing sanctions against Cigna for its Medicare Advantage and prescription drug plans.
TX – House Passes Bill to Allow Virtual Visits
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 Announces Change Intended to Streamline Exchange Plan Enrollment
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.
