Tagged with ICD-10 Diagnosis Coding
MA – New Health Model Helps Identify Social Determinants
Massachusetts Medicaid administrator, MassHealth, is taking an innovative approach to control costs through implementation of a new health model that helps identify and address social determinants of health.
Humana – Cardiology Code Edits
Humana released three Cardiology code edits that will be effective as of August 31, as well as significant revisions to certain medical coverage policies.
Cigna Updates Electrical Stimulation Therapy and Devices Policy
Cigna has released an update to its Electrical Stimulation Therapy and Devices policy and is also implementing a new policy, related services, supplies, drugs and equipment for claims processed on or after July 9, whether or not the supplies are billed with the device or separately.
Humana Correct Coding Update
Humana has updated it list of correct coding for certain procedure, effective July 6, 2017.
CMS 2018 MA, Part D Final Payment Rates Announced with 0.45% Increase
CMS has released 2018 Medicare Advantage and Part D payment rates, announcing a 0.45% average rate increase. According to CMS, the changes made aim at providing benefit flexibility and efficiency which will allow Medicare enrollees to choose the care that best fits their health needs.
OH – Medicaid Oversight Committees Announce Changes to State Behavioral Health Redesign
The Ohio Department of Medicaid (ODM) and Ohio Department of Mental Health and Addiction Services (OhioMHAS) has announced two major policy and operational updates related to Behavioral Health Redesign. These policy modifications include the expansion of MH Day Treatment service for Qualified Mental Health Specialists (QMHSs) as well as the removal of the limit of 24 hours for Mental Health or SUD Nursing services per patient, per calendar year.
DOJ v. UnitedHealth
The DOJ moves forward with legal action against two insurers accused of erroneous coding and inflated billing – UnitedHealth and WellMed Medical Management.
CMS Proposes 0.25% Medicare Advantage Rate Increase
CMS has announced proposed changes to the Part D prescription drug program and Medicare Advantage for calendar year 2018.
Harvard Pilgrim Updates Eylea Medical Policy and 2017 Fee Schedule
Harvard Pilgrim has updated the Eylea Medical Policy to remove some codes that were not consistent with the policy’s intent and will now include ICD-10 codes newly released by CMS. In addition, the insurer says it will update its Standard professional fee schedule, incorporating recently released Medicare relative value units (RVUs) and laboratory rates for 2017.
