Tagged with Medicaid Billing

Anthem Updates Assistant Surgeon Policy and Code List

Anthem has posted its updated Assistant Surgeon policy and code list to reflect CPT® and Healthcare Common Procedure Coding System (HCPCS Level II) coding changes for 2017 as well as updates based on American College of Surgeons (ACS) and CMS information.

CMS Releases Quality Payment Program Proposed Rule

On June 20th, CMS released its 2018 Medicare Quality Payment Program (QPP) proposed rule. Officially titled, “CY 2018 Updates to the Quality Payment Program,” the rule includes key policy updates that seek to streamline reporting requirements and simplify participation under the Merit-Based Incentive Payment System (MIPS) [Track 1] and the Advanced Alternative Payment Model (Advanced APM) [Track 2] pathways created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

End-Stage Renal Disease Proposed 2018 Policy and Payment Rate Changes

CMS has issued a proposed rule that would update payment policies for the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS). The ESRD PPS proposed rule is one of several for CY 2018 that reflect a broader strategy to relieve regulatory burdens for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility, and innovation in the delivery of care.

IN – Request for Medicaid Recipients to Work Could Face Challenges

The Governor of Indiana is seeking permission from CMS to require some Medicaid beneficiaries to be employed or searching for work to be eligible for the Healthy Indiana 2.0 (HIP) plan, but since public comments were not permitted, the state request could be facing some legal challenges.

OH – Budget Passed, Medicaid Freeze Vetoed

On June 28, the Ohio Senate approved the 2018-19 state budget bill in a vote of 24-8. On June 30, Governor John Kasich signed the 2018 state budget into law – vetoing 47 provisions. The Ohio House then voted, on July 6, to override 11 of the 47 line items vetoed.

New Medicare Cards to Offer Greater Protection

Increasing efforts toward the prevention of fraud and identity theft, the Medicare Access and CHIP Reauthorization Act (MACRA) mandates that all Social Security numbers be roved from all Medicare cards by April 2019. CMS will begin mailing the new cards with randomly-assigned and unique identifying number in place of the beneficiary’s Social Security number in April 2018.

CMS Releases 1991-2014 Health Care Spending by State

CMS’ Office of the Actuary (OACT) has released its ‘State Health Expenditure Accounts’ report detailing state-level health care spending data for the period 1991-2014. The data reveals large differences of personal healthcare spending from region to region as well as growth in spending in non-expansion states that show similar rates in Medicaid expansion states.

NH – Minuteman Health ask for 30% Rate Increase

The second-largest insurer in the New Hampshire Affordable Care Act (ACA) market has requested average rate hikes of 30% for 2018, citing Medicaid expansion and federally imposed risk adjustments as the cause for the request.

CT – Billing Clarification for Brand Name Medications on the PDL

The Pharmaceutical & Therapeutics (P&T) Committee has modified the list of preferred prescription products. As an aid to providers, Connecticut’s Medical Assistance Program has released clarification on billing requirements for a pharmacy when a brand name medication is dispensed.

FY 2018 Budget Released

The White House has released its budget proposal for fiscal year (FY) 2018 and presented it to Congress. Totaling at $4.1 trillion, the proposal requests $69 billion in discretionary budget authority and $1,046 billion in mandatory funding to help the Department of Health and Human Services (HHS).

Senate Finance Committee Approves Chronic Care Bill

The Senate Finance Committee unanimously passed the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017. The legislation seeks to expand telehealth services to Medicaid populations and has received a favorable score by the Congressional Budget Office.