Tagged with Emergency Medicine
By Joe Laden, Vice President of Client Management Overall healthcare costs have been rising over the years, due to factors such as the aging population and increased use of medical technology. The administration of healthcare reimbursement to providers accounts for a significant portion of healthcare costs, and some of these administrative costs have been decreasing…
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.
On October 4, New York City’s public hospital system, NYC Health + Hospitals, established a new program to provide health care to New York City’s uninsured, called NYC Care. The program originally launched in August and has a current enrollment of 5,000 people, and will expand into Brooklyn and Staten Island in January 2020.
On September 26, CMS issued The Omnibus Burden Reduction (Conditions of Participation) Final Rule, which advances the ‘Patients over Paperwork’ initiative aimed at reducing administrative costs in healthcare.
The Texas Health and Human Services Commission announced, on October 1, that the state will be given $11.6 billion over the next three years to help reimburse health care providers for indigent services and is intended to benefit hospitals, clinics, public ambulance, and dental providers.
In a letter to the House Ways and Means Committee, Chairman Richard Neal has proposed that the Departments of Health and Human Services (HHS), the U.S. Labor and Treasury Department, along with other interested parties, consolidate their efforts to develop standards for rates for surprise bills.
Two physician lawmakers have proposed new legislation that aims to improve the accuracy of information in health plan provider directories and protect patients from surprise out-of-network bills. The Improving Provider Directories Act (HR 4575) would require health plans to provide an avenue for people to report errors in provider directories, in a “highly visible way”.
The president, on October 3, signed an executive order directing the Department of Health and Human Services to increase efforts to provide more insurance plan options under Medicare Advantage and to remove regulations that are considered burdensome to health care providers. The order is intended to protect traditional Medicare and private Medicare Advantage while ramping up alternative payment models, time spent with patients, access to innovative technology and reducing the regulatory burdens on providers.
Effective July 1, Aetna will require prior authorization for certain procedures under its Enhanced Clinical Review Program with eviCore healthcare.
Beginning July 1, Aetna will require authorization for its enhanced clinical review program with eviCore healthcare for certain outpatient radiation therapy services.
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, on June 28, released its report summary of the Affordable Care Act (ACA) risk adjustment program for the 2018 benefit year. The analysis found that 572 health insurers offering ACA plans participated in the program in 2018, and transfers between the companies totaled $10.4 billion.
CMS announced, on July 2, that it finalized its national coverage policy for Ambulatory Blood Pressure Monitoring (ABPM), extending coverage of blood pressure monitoring devices to all Medicare beneficiaries suspected of reporting abnormal blood pressure levels when administered in clinical settings.
CMS, on June 21, issued several new or updated frequently asked questions documents on the Bundled Payments for Care Improvement (BPCI) Advanced Model, an Advanced Alternative Payment Model launched last October that will run through 2023.
The CMS has re-issued a memorandum on emergency stabilization and treatment of newborn infants that could cause fresh anxiety for hospitals and physicians over abortion and care for pregnant women and severely disabled infants.
The Pennsylvania Senate has approved a package of bills to collectively combat the state’s heroin and opioid epidemic. The legislation includes seven bills, each designed to address specific issues and areas pertaining to opioid prescription and abuse.
CMS has provided ICD-10-CM coding updates for the fiscal year, starting October 1, 2019 and ending September 30, 2020.
A new legislation has been introduced, that is intended to protect New York residents from unexpected surprise bills from hospital emergency department visits would give insurers the ability to pay hospitals outside their networks what they consider reasonable for emergency care, rather than what the hospital charged.
Senate Health Committee leaders have proposed a legislative health care package which aims to reduce health care costs for individuals by addressing surprise medical bills, drug price transparency, and pharmacy benefit management.
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.