Tagged with Medicaid Billing
Pennsylvania Implements Preferred Drug List
Pennsylvania’s Medical Assistance Program implemented a statewide Preferred Drug List (PDL) effective on January 1, 2020. The PDL will be utilized by the fee-for-service program and all eight Medical Assistance (MA) managed care organizations (MCOs) in the state.
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.
ACR Seeks Urgent Action Opposing Cuts to Radiology
The American College of Radiology (ACR) is seeking help in its efforts to urge Congress to stop CMS from implementing proposed changes to the Evaluation and Management (E/M) Codes that could result in severe cuts to radiology.
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.
Humana Releases Update to Facility Observation Services Payment Policy
Humana has issued a new claims payment policy for appropriate billing and documentation of facility observation services.
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.
House Approves CR, Senate Unveils Draft HHS Bill
The House, on September 19, approved a short-term spending measure that will keep the government funded through mid-November and avoid a shutdown at the beginning of October. Additionally, the Senate, on the 18th, released the FY2020 subcommittee chairman’s recommendation for the Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS) Appropriations bill.
CMS Notice on Bypassing Payment Window Edits for Donor Post-Kidney Transplant Complication Services
CMS has posted a notice for physicians, hospitals, and other providers billing Medicare Administrative Contractors (MACs) to ensure the payment window edits are bypassed when processing claims for donor post-kidney transplant complications services.
CMS Issues Renewed Guidance to Ensure Medicaid Program Integrity
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.
Florida Governor Extends 30-Day Retroactive Medicaid Eligibility
The Governor of Florida has extended legislation reducing retroactive Medicaid eligibility from 90 to 30 days for another year. The bill also mandates the state Agency for Health Care Administration to submit a report to the legislature about the impact of the change on patients and health care providers by January 2020.
Pennsylvania Lawmakers Propose Bill Package to Combat Opioid Crisis
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.
Illinois Legislation Targets Medicaid Managed Care Claim Denials
The Illinois Legislature unanimously passed a health care reform package, which requires Medicaid managed care plans to pay claims within 30 days or face a penalty.
Anthem Announces Fee Schedule Changes
Anthem Blue Cross and Blue Shield (Anthem) recently notified members of the upcoming changes to its Anthem Plan Fee Schedules, scheduled to take place July 1.
MACPAC Recommends Medicaid Policy Changes For Drug, Hospital Payments
The Medicaid and CHIP Payment and Access Commission (MACPAC) has released its 2019 Report to Congress on Medicaid and CHIP which includes recommendations Medicaid policy changes for outpatient prescription drug and hospital payments, and program integrity.
House Renews Several Medicaid Programs, Including Payment Pilot for Mental Health Clinics
The House passed legislation to renew several Medicaid programs, including an eight state pilot that pays higher reimbursement rates to mental health clinics that offer comprehensive mental health services regardless of ability to pay, offering assistance to patients move out of assisted living facilities, covering costs for individuals whose spouses are in long-term care, and preventing Medicaid fraud.
Texas Lawmakers Pass Three Patient Protection Bills Aimed at Surprise Billing
The Texas legislature has passed three patient protection bills aimed at Medicaid managed care and safeguarding against surprise medical bills.
Supreme Court Rules Against HHS in DSH Payment Case
In a 7-1 decision, the Supreme Court ruled in favor of the nine hospitals that said the Department of Health and Human Services (HHS) violated the Medicare Act when it changed Medicare’s reimbursement adjustment formula for disproportionate share hospitals without providing notice and opportunity to comment.
CMS Finalizes Rule to Update and Modernize PACE
CMS has announced the release of a final rule designed to “update and modernize” the Programs of All-Inclusive Care for the Elderly (PACE) program, based upon best practices in caring for frail and elderly individuals.
CMS Final Rule Blocks States from “Diverting” Provider Medicaid Payments to Third Parties
CMS, in early May, released the Medicaid Provider Reassignment Regulation final rule removing a state’s ability to divert portions of Medicaid provider payments to third parties outside of the scope of what the statute allows. Under the rule, CMS is revoking the authority of states to “divert” certain Medicaid provider payments to a third party to fund other costs on behalf of the provider “for benefits such as health insurance, skills training, and other benefits customary for employees.”
New Jersey DHS Provides Update on MLTSS, Nursing Facility ‘Any Willing Qualified Provider’ Reimbursement Model
New Jersey’s reimbursement parameters for its MLTSS program are intended to be transitioned to a new, quality-based Any Willing Qualified Provider (AWQP) reimbursement model. DHS says it intends to award AWQP designation status to NFs this spring and review it annually.
