Tagged with Medicaid Billing

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.

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.

Aetna Balance Billing Notice for Medicare Beneficiaries

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).

Massachusetts Introduces New Medicaid Rules

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.

CMS Hospital Medicaid Reimbursement Rule Annulled

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.”

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.