Tagged with EMR EHR Electronic Medical Records
HHS Releases Final Interoperability Rules
CMS and the Department of Health & Human Services (HHS)’ Office of the National Coordinator for Health Information Technology have released two interoperability rules. The new rules aim to make it easier for patients to access and share their information and aim to end information blocking by requiring public and private entities to securely share health information with patients and penalize those who fail to do so.
HHS Releases Final Recommendations on Reducing Clinical Burden
The U.S. Department of Health & Human Services (HHS) released the final version of its Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs. The strategy aims to reduce clinician burden through incremental changes that will push of electronic health record systems toward interoperability while easing regulatory burden.
Anthem Ohio Clinical Laboratory Improvements Amendments
Beginning May 1, claims that are submitted to Anthem Blue Cross and Blue Shield (Anthem) of Ohio for laboratory services subject to the Clinical Laboratory Improvement Amendments (CLIA) 1988 federal statute and regulations will require additional information to be considered for payment.
UnitedHealthcare Implements Enhancements to Procedure to Modifier Policy
UnitedHealthcare has announced plans to implement certain changes to enhance the Procedure to Modifier Policy for Medicare Advantage plans to include modifiers CT, FX and FY.
New York Updates Quality Measures for Medicaid Managed Care Organizations in the Value Based Payment Program
The New York Department of Health released the 2020 value-based payment (VBP) Reporting Requirements Technical Specifications Manual for Measurement Year (MY) 2019. The report includes an overview of the specific quality measure reporting requirements for each VBP arrangement, as well as a description of the changes to the measure sets from 2018 to 2019.
Humana Releases Latest Claims Payment Policy Updates
Humana has published its latest medical claims payment policy updates, including its reimbursement policy for ambulance transportation, requirements for billing and documentation of observation services, as well as a new policy for obstetric billing, including antepartum, delivery and postpartum care.
Executive Order Issued to Protect Traditional Medicare and MA Plans
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.
UnitedHealthcare Issues Recent Commercial Reimbursement Policy Updates
Effective September 1, UnitedHealthcare (UHC) will add a new policy for molecular pathology and will make changes to its procedure to modifier policy.
New Jersey Will Transition to a State-Based Exchange
On March 22, the governor of New Jersey has announced that the state will transition from the federally operated Healthcare.gov exchange platform to a state-based exchange by the 2021 plan year. According to state officials, the change will give the state more control over its health insurance market.
CMS Publishes Final CY 2019 Medicare Physician Fee Schedule Rates and Policies
On November 1, CMS issued the Calendar Year (CY) 2019 Medicare Physician Fee Schedule (PFS) final rule. The final rule updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2019.
CMS Releases CY 2019 Physician Fee Schedule Final Rule
On November 1, CMS released its Medicare Physician Fee Schedule final rule for calendar year (CY) 2019. The latest update includes changes to the Quality Payment Program as well as documentation and payment adjustments for evaluation and management services.
New Data Shows 93% of Eligible Clinicians Received MIPS Payment Under QPP Last Year
New data released by CMS shows 93% of eligible clinicians who participated in the Merit-Based Incentive Payment System (MIPS) under the Quality Payment Program (QPP) received positive payment adjustments for their MIPS performance last year.
New Hampshire State Senator Proposes Bill Targeting Surprise Emergency Room Bills
A New Hampshire senator has announced plans to file legislation that is designed to address surprise medical bills that some patients say keep coming after a visit to the emergency room for an illness or injury.
CMS Introduces New Interoperability Initiative
CMS has announced its new initiative for interoperability, MyHealthEData. The program has been designed to empower patients by giving them control of their healthcare data, and allowing it to follow them through their healthcare journey.
CMS Launches New QPP Data Submission System for Clinicians
CMS has launched a new data submission system for clinicians participating in the Quality Payment Program (QPP), designed to reduce administrative burdens and streamline the data submission process.
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.
Medicare HOPPS, ASC Rates and Policies Finalized for CY 2018
CMS has published the final rule updating Medicare Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgical Center (ASC) Payment System rates and policies for calendar year 2018 (CY 2018).
Connecticut Department of Social Services Implements New Medically Unlikely Edits Review Process
The Connecticut Department of Social Services (DSS) recently released a memo announcing implementation plans for its process for reviewing claims denied solely due to exceeding the National Correct Coding Initiative (NCCI) Medically Unlikely Edit (MUE) limit for dates of service July 1st, 2016 and forward.
CMS Announces Transition of eCQMs to CQL for CY2019 Reporting Periods
CMS, on October 31st, announced that electronic clinical quality measures (eCQMs) in CMS quality programs will be transitioned to use the Clinical Quality Language (CQL) standard (CQL Release 1, Standard for Trial Use (STU) 2) for logic expression. Additionally, CMS has issued revised technical release notes (TRNs) for the addendum to the electronic clinical quality measure (eCQM) annual update specifications for 4th Quarter 2017 reporting and 2018 reporting periods.
CMS Issues Guidance on Information Blocking Prevention in MIPS
CMS has published guidelines detailing requirements as to how Merit-Based Incentive Payment System (MIPS)-eligible clinicians must attest in order to prove they have made a good-faith effort to implement and use EHR technology that supports the timely exchange of healthcare information.
