Tagged with Hospitalist Billing
Telehealth Benefits Temporarily Expanded
The White House has announced that beginning on March 6, Medicare administered by CMS will temporarily pay clinicians to providing virtual visits and other telehealth services to beneficiaries.
CMS Issues Information Related to COVID–19 Individual and Small Group Market Insurance Coverage
CMS has issued a fact sheet detailing existing federal rules governing health coverage provided through the individual and small group insurance markets that apply to the diagnosis and treatment of COVID-19.
CMS Provides MIPS Reporting Relief and Extension
CMS is issuing an extension to the 2019 data submission deadline through April 30, 2020. Specifically, the agency is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission.
CPT® Releases New Coronavirus (COVID-19) Code & Description for Testing
A new CPT® code has been created that streamlines novel coronavirus testing offered by hospitals, health systems and laboratories in the United States. The new code became effective March 13, 2020 for use as the industry standard for reporting of novel coronavirus tests across the nation’s health care system.
UnitedHealthcare Requiring Hospital Outreach Labs to Contract as Independent Reference Labs
Effective May 1, UnitedHealthcare (UHC) will deny any non-patient lab test claims submitted by hospital outreach labs if billed under the hospital’s facility participation agreement. The insurer is requiring that hospital outreach labs are credentialed and contracted as an independent reference lab in order to get their non-patient lab test claims paid.
Florida First State to Receive Federal Approval for 1135 Medicaid Waiver to Address COVID-19
CMS has announced its approval of Florida’s Section 1135 Medicaid waiver request, giving the state greater flexibility to respond to COVID-19. These increased flexibilities include the removal of service barriers; streamlining provider enrollment processes; allowing care to be provided in alternative settings; suspending certain nursing home screening requirements; and extending deadlines for appeals.
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.
$8.3B Coronavirus Funding Bill Approved
During the first week in May, the U. S. House and Senate approved an $8.3 billion funding bill to support ongoing efforts to combat COVID-19 (Coronavirus). On March 6, the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (H.R. 6074) was finalized by the president
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.
Ohio Revises Definition of Ambulatory Surgical Facilities
Ohio has released the recently revised definition of an Ambulatory Surgical Facility (ASF), as part of the new 2020/2021 general operating budget legislation. The change expanded the ASF definition, which may require some previously unlicensed facilities to obtain licensure.
Comprehensive CJR Model Proposed Extension and Changes
On February 20, CMS issued a proposed rule which recommends a three-year extension and changes to the episode definition and pricing in the Comprehensive Care for Joint Replacement (CJR) Model.
CMS Announces Plans to Change Prior Authorization Rules
CMS Administrator, Seema Verma, on February 11, announced the agency’s intent to reform prior authorization regulations later this year. According to Verma, the changes “will reduce administrative waste, increase patient safety and free physicians to spend time caring for their patients.”
CMS Announces New Medicaid Initiative to Limit Drug Coverage, Keep Rebate Obligations
On January 30, CMS announced the new Healthy Adult Opportunity (HAO) initiative that it will allow states to limit drug coverage under Medicaid without reducing manufacturer rebate obligations.
Maryland Owes Millions of Dollars to Mental, Behavioral Health Providers
Mental and behavioral health providers in Maryland are owed millions of dollars for services that have gone unpaid because of a malfunctioning state payment system. The Maryland Health Department has begun sending providers estimated payments totaling about $32 million per week until the system is fixed.
CMS Issues Quarterly Update to the NCCI PTP Edits
As a guide for physicians, providers, and suppliers billing Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries, CMS has released an update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits. The agency hopes the update will promote national correct coding methodologies and to control improper coding that can lead to inappropriate payment in Part B claims.
CMS Issues Additional Guidance on D-SNP Integration Requirements
On January 17, CMS issued a memorandum providing additional guidance clarifying Medicare-Medicaid integration requirements for Dual Eligible Special Needs Plans (D-SNPs). The memorandum is intended to clarify distinctions between fully integrated D-SNPs (FIDE SNPs) and highly integrated (HIDE SNPs); permissibility of carve-outs of behavioral health services and long term services and supports (LTSS) for FIDE SNPs and HIDE SNPs; alignment of D-SNP and companion Medicaid plan service areas; and compliance with integration requirements for DSNPs that only enroll partial-benefit dually eligible individuals.
Year-End Spending Bills Include Millions toward Key Radiology Research Efforts
The year-end spending bill package signed, last month, by the president will provide billions in funding toward research that’s key to radiologists’ work. The legislation allocates $41.7 billion to the National Institutes of Health (NIH) and also provides $338 million to the Agency for Healthcare Research and Quality to support NIH research initiatives.
CMS, HHS Proposes Changes to Stark Law and Anti-Kickback Statute Reforms
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.
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.
UnitedHealthcare Expands Prior Auth Requirements and Site-of-Service Medical Necessity Reviews for Certain Surgeries
UnitedHealthcare has expanded prior authorization requirements and site of service medical necessity reviews for certain surgeries in an effort to shift surgical procedures to less expensive locations.
