Tagged with EMR EHR Electronic Medical Records
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.
2018 eCQM Value Set Addendum for EPs, ECs Released
CMS has released an addendum to the electronic clinical quality measure (eCQM) annual update specifications originally published in May 2017. This addendum updates eCQM value sets for the 2018 performance period for Eligible Professionals (EPs) and Eligible Clinicians (ECs).
VA Issues Proposed Rule to Allow Telemedicine Across State Lines
The US Department of Veterans Affairs (VA) has proposed a rule that would preempt state laws restricting the ability of VA healthcare providers to supply telehealth services to veterans across state lines or within states, intended to increase the availability of mental health, specialty care, and general clinical care to veterans, especially in rural areas.
CMS Releases Quality Payment Program Proposed Rule
On June 20th, CMS released its 2018 Medicare Quality Payment Program (QPP) proposed rule. Officially titled, “CY 2018 Updates to the Quality Payment Program,” the rule includes key policy updates that seek to streamline reporting requirements and simplify participation under the Merit-Based Incentive Payment System (MIPS) [Track 1] and the Advanced Alternative Payment Model (Advanced APM) [Track 2] pathways created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
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 gives over 800K Physicians Reprieve from MACRA Reporting in 2017
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.
