Tagged with Medicaid Billing
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.
As part of an ongoing effort to reform the state’s Medicaid program and ensure the purchase of cost–effective, high quality healthcare, and better outcomes for its beneficiaries, New York has reduced the number of eligible breast cancer surgery facilities for Medicaid recipients.
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.
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 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).
The Florida Department of Health (DOH) has announced plans to privatize management of the Children’s Medical Services Managed Care plan (CMS plan).
CMS has announced the deadline extension for providers planning to submit an expression of interest (EOI) for the Low Volume Appeals (LVA) Initiative.
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.
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.
A recent analysis by the Center for Community Solutions finds that Ohio’s proposed Medicaid eligibility requirements would cost the state $378 million over five years in added administrative costs for county governments.
The New Hampshire Senate recently passed a bill reauthorizing the state’s Medicaid expansion program to continue for another five years, transition to managed care in 2019, and imposes member work requirements.
The Governor of Illinois has signed a new Medicaid funding plan that makes changes to the hospital assessment formula and is intended to ensure that hospitals whose patients overwhelmingly rely on Medicaid coverage receive additional funding.
Connecticut lawmakers have introduced a bill that would implement work or volunteer requirements for adult Medicaid recipients and prohibit the Department of Social Services (DSS) from removing work requirements for Supplemental Nutrition Assistance Program (SNAP) recipients.
Anthem Blue Cross and Blue Shield (BCBS) has published a notice informing health care professionals and policyholders that the insurer will no longer proceed with the reimbursement policy impacting physician use of payment Modifier 25.
Aetna has issued a notice reminding providers and billing professionals that Medicare beneficiaries under the Qualified Medicare Beneficiary (QMB) program should not be billed for cost sharing (balanced billing).
CMS has issued a notice of proposed rulemaking (NPRM) aimed at providing state flexibility from certain regulatory access to care requirements within the Medicaid program.
Massachusetts’ Medicaid program, MassHealth, has implemented major changes to the structure of the program, including shifting to accountable care organizations, allowing health care providers to address social determinants of health, and reimbursements will be tied to provider performance.
A U.S. District Judge has annulled a new rule from CMS which allowed the Agency to count private insurance payments against hospitals’ Medicaid reimbursement amounts, known by hospitals as “double dipping.”
Pennsylvania Updates Medication-Assisted Treatment (MAT) Prior-Authorization Requirements for Substance Use Disorder
Pennsylvania has announced plans to remove a pre-authorization requirement for Medicaid recipients to access Medication-assisted treatments (MAT) for opioid/substance abuse addiction.
New York Finalizes Draft Waiver Transition Plan for Individuals with Intellectual and Developmental Disabilities
The New York Office for People with Developmental Disabilities (OPWDD) has finalized its Draft Waiver Transition Plan which lays out their vision for reform of the system serving people with intellectual and developmental disabilities (IDD), “People First Care Coordination.” The Transition Plan describes the development of Care Coordination Organizations, which will provide Health Home Care Management services.