Tagged with Medicaid Billing
CMS posted a final rule that reissues, with additional explanation, the risk adjustment methodology that CMS previously established for transfers, charges, and making of payments related to the 2017 benefit year.
CMS has published an updated 2018 CMS Quality Reporting Document Architecture Category III (QRDA III) Implementation Guide (IG) for Eligible Clinicians and Eligible Professionals (EPs). The update includes renaming of the Merit-based Incentive Payment System (MIPS) Advancing Care Information performance category, as well as changes to the MIPS performance period reporting.
CMS has announced plans to publish an addendum to the electronic clinical quality measure (eCQM) value sets to align with the most recent releases to terminologies.
Rhode Island officials are requesting an extension of the state’s 1115 demonstration to expand the use of value-based care within the state’s Medicaid program.
CMS has issued a rule finalizing 2019 updates to Medicare payment policies and rates for the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) and to the IPF Quality Reporting (IPFQR) Program.
CMS is proposing updates and policy changes under the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System.
Rhode Island has revised its Medicaid policy to cover the cost of treatment for the 22,660 state residents living with the Hepatitis C virus.
Anthem’s behavioral health medical policies and clinical guidelines currently in place for reviewing of behavioral health services, will be replaced by the MCG Care Guidelines 22nd edition Behavioral Health guidelines.
Humana has updated its Medicare Advantage, Commercial, and Medicaid payment policies for health care services delivered using electronic information and telecommunications technologies.
UnitedHealthcare (UHC) has updated its advance notification/prior authorization requirements for several services and procedures, as well as three specialty medications, effective July 1.
The Maine House has sustained the governor’s veto of funding bill to expand Medicaid to additional 70,000 Maine residents.
Illinois has received federal approval for the state’s Medicaid funding model, known as the Hospital Assessment Program, to implement a tax that would help raise funds for hospitals across the state.
The House of Representatives has passed a comprehensive piece of legislation specifically designed to help combat opioid use throughout the United States.
On July 1, the Governor of New Jersey signed the 2019 Fiscal Budget into law. The $37.4 billion budget includes increased funding for the Department of Health as well as the state’s Department of Human Services.
CMS has announced the launch of its Data Element Library (DEL), a new free database designed to support the exchange of electronic health information between providers and facilities.
The Department of Labor (DOL), on June 18, issued a final rule that will expand consumer availability of association health plans (AHPs) as of September 1, 2018.
Beginning in July, UnitedHealthcare (UHC) will make changes to some commercial reimbursement policies, including after hours and weekend care, intraoperative neuromonitoring, and its professional and technical component policy for duplicate or repeat services of global test only.
Effective August 1, Humana will implement changes to the time frame for peer-to-peer review process for its Medicare Advantage (MA) health plans.
A resolution has been introduced in Delaware that seeks to allow the state to look-into potential Medicaid buy-in options.
The New York Assembly has passed the New York Health Act, a legislation seeking the establishment of a universal single payer health plan that would provide comprehensive health coverage.