Tagged with Medicaid Billing
CMS on January 8th introduced its new voluntary bundled payment model, Bundled Payments for Care Improvement Advanced (BPCI Advanced).
CMS, in a letter to state Medicaid directors on December 15th, said it will no longer accept state Medicaid waivers seeking new or renewed federal matching funds for designated state health programs (DSHP).
The Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) recently announced that the repeal of the Affordable Care Act’s (ACA) individual mandate will significantly cut the cost to fund the Children’s Health Insurance Program (CHIP) for five more years.
Beginning January 2019, in hopes of improving health outcomes for its residents, Delaware’s Medicaid program will soon cover treatment visits for people struggling with obesity.
In an effort to curb reliance on opioid painkillers, an alternative pain management method was expanded under Ohio’s Medicaid program. Effective January 1st, the expansion will allow Medicaid patients to receive acupuncture treatment by licensed non-physician acupuncturists.
Anthem BCBS of Indiana has issued notice of medical policy revisions approved by the Medical Policy and Technology Assessment Committee (MPTAC).
Starting in 2018, more claim payments and remittance advice issued to Anthem providers will be made on a weekly basis.
CMS has posted the application fee amount for any enrollment application submitted on or after January 1, 2018 and on or before December 31, 2018.
CMS has submitted a proposed rule that, if finalized, would revise the Medicare Advantage program (Part C) regulations and Prescription Drug Benefit program (Part D) regulations to implement certain provisions of the Comprehensive Addiction and Recovery Act (CARA) and the 21st Century Cures Act.
Healthcare New England (HNE) has issued updated anesthesia guidelines surrounding the use CPT codes and claim submissions.
CMS issued a notice announcing two new Positron Emission Tomography (PET) radiopharmaceutical unclassified tracer codes to be used temporarily pending the creation/approval/implementation of permanent CPT codes.
Indiana Health Coverage Programs Revises Rates for Select Clinical Lab Services Based on 2018 Medicare Rates
Indiana Health Coverage Programs’ (IHCP) has announced its plans to adopt the 2018 Medicare rates for any clinical laboratory procedure code for which the IHCP’s current reimbursement rate exceeds the 2018 Medicare rate.
New York State has submitted its Final Draft Transition Plan for the Children’s Medicaid System Transformation to CMS.
The Pennsylvania Senate passes bill to reauthorize the Children’s Health Insurance Program through 2019. The bill now moves onto the Governor’s office for approval.
The Wisconsin Department of Health Services has requested a five-year extension for the BadgerCare Reform Demonstration (Section 1115) waiver, set to expire December 31, 2018.
Providers and insurance groups are in favor of CMS’ plans to develop a demonstration project that will test the effects of allowing clinicians to receive credit for financial risk-based arrangements with Medicare Advantage (MA) plans.
CMS Reinforces Rule Prohibiting Billing Dually Eligible Individuals Enrolled in Qualified Medicare Beneficiary Program
CMS has issued a notice to reinforce the rule that Medicare providers and suppliers should not bill beneficiaries enrolled in the Qualified Medicare Beneficiary (QMB) program for Medicare cost-sharing.
CMS has announced premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs for 2018.
Humana has issued several CPT code edits for specialties including Surgery, Pathology, and Radiology.
The New Jersey Department of Human Services (DHS) last month announced that it has expanded the list of covered health benefits available to align behavioral health coverage for Medicaid Long Term Services and Supports (MLTSS), Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs), and Division of Developmentally Disabled (DDD) MCO members participating in the New Jersey FamilyCare (NJFC) Medicaid managed care program.