Tagged with Medicaid Billing
New Proposed Rule Seeks to Streamline Medicaid Managed Care Programs
CMS has released a new proposed rule that would make changes to current Medicaid managed care programs and speed up state managed care contracting processes.
HHS Advances Payment Model to Lower Drug Costs for Patients
HHS has announced a new International Pricing Index (IPI) payment model to reduce what consumers in the United States pay for prescription drugs. Under the new model, Medicare’s payments for select physician-administered drugs would shift to a level more closely aligned with prices in other countries.
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.
Ohio Proposed Rule to Require Providers to Accept Standard Form for PHI
The Ohio Department of Medicaid (ODM) has proposed the adoption of a proposed rule which would require two standard authorization forms for the use and disclosure of protected health information (PHI).
CMS Proposes to Lift Regulations, Ease Provider Burden
Last month, CMS released a proposed rule to remove some of the Medicare participation requirements currently in place for health care facilities. According to the press release, the agency estimates that policies from the proposed rule could potential save hospitals and other facilities approximately $1.12 billion annually.
Senate, House Pass Major Opioid Legislation Package
The Senate and House each passed a package of 70 bills aimed at addressing the country’s opioid crisis. The package, which has strong bipartisan support, is expected to cost $8.4 billion.
Fourth Quarter ASC Payment Rate Updates Released
CMS has released its October addenda, providing fourth quarter updates to the ASC payment system.
Medicare Advantage Premiums Expected to Drop Again
According to CMS, Medicare Advantage premiums are expected to decrease by 6% on average in 2019 with membership likely expanding to more than 36% of Medicare beneficiaries.
CMS Announces New Streamlined User Experience for Medicare Beneficiaries
CMS, on October 1, announced a multi-year initiative that will empower patients and update Medicare resources to meet beneficiaries’ expectation of a more personalized customer experience. The eMedicare initiative will modernize the way beneficiaries get information about Medicare and create new ways to help them make the best decisions for themselves and their families.
Illinois Medicaid Program Expands Telehealth Reimbursement to Increase Access to Behavioral Health and Other Critical Services
Illinois has passed a series of bills that meaningfully expand the reimbursement of telehealth services delivered to its Medicaid patients. Illinois’ legislators, telemedicine advocates, healthcare providers and patient advocacy groups collaborated in an impressive effort to develop focused and targeted legislative solutions that effectively balance the need to get critical behavioral health services to patients in need with long-standing concerns that increasing access via telehealth will result in greater health care costs to a state already experiencing severe financial challenges.
New Jersey Medicaid Issues Telehealth Coverage and Reimbursement Guidance
October 2018 ~ The New Jersey Department of Human Services, Division of Medical Assistance and Health Services (DMAHS) issued a newsletter to NJ FamilyCare (NJFC) providers to clarify the requirements for the provision and billing of NJFC services via telehealth and telemedicine. The guidance comes as a follow-up to the New Jersey Telemedicine and Telehealth…
eCQM Value Set Update for 2019 Reporting and Performance Periods Published
CMS and the National Library of Medicine (NLM) has published the most recent updates to the electronic clinical quality measure (eCQM) value sets. The updated sets include ICD-10 Clinical Modification (CM) and Procedure Coding System (PCS), SNOMED CT, LOINC, and RxNorm.
Virginia – House Passes Medicaid Expansion
The Virginia House of Delegates recently passed a state budget that includes funding for Medicaid expansion and stricter work requirements. If finalized, the state budget legislation would expand Medicaid eligibility to about 400,000 low-income adults.
Humana Claim Processing Edits
Humana has released several claims processing edits, including updates to Outpatient Prospective Payment System (OPPS), Modifiers 96 and 97, HCPCS Drugs & Biologicals, and other policies.
New Hampshire House and Senate Approve Medicaid Expansion Bill
The New Hampshire House Health and Human Services Committee and Senate have passed legislation to reauthorize the state’s Medicaid expansion program for an additional five years, as well as add work requirements, and will also transition beneficiaries from the individual insurance exchange into a managed care model.
Illinois State Medicaid Transition to Managed-Care Health Plans
Illinois Medicaid has transferred the healthcare coverage of approximately 550,000 residents to the state managed care plan, HealthChoice Illinois, and will soon see their health care handled by managed care organizations (MCO).
Florida Medicaid Children’s Medical Services Program to be Privatized
The Florida Department of Health (DOH) has announced plans to privatize management of the Children’s Medical Services Managed Care plan (CMS plan).
CMS Extends Low Volume Appeals (LVA) Initiative Deadline
CMS has announced the deadline extension for providers planning to submit an expression of interest (EOI) for the Low Volume Appeals (LVA) Initiative.
MedPAC Releases 2018 Report
The Medicare Payment Advisory Commission (MedPAC) has released its March 2018 Report to Congress on Medicare payment policy, detailing its payment update recommendations to Congress, which the Commissioners voted on in January.
Anthem Blue Cross and Blue Shield Virginia Coverage and Clinical Guideline Update
Effective May 1, Anthem Blue Cross and Blue Shield in Virginia (BCBS VA) will implement new and revised coverage guidelines approved at the most recent quarterly Medical Policy and Technology Assessment Committee meeting.
