Tagged with Medicaid Billing
CMS has released 2018 Medicare Advantage and Part D payment rates, announcing a 0.45% average rate increase. According to CMS, the changes made aim at providing benefit flexibility and efficiency which will allow Medicare enrollees to choose the care that best fits their health needs.
The bill hopes to expand existing telehealth services for Medicare patients by improving Medicare reimbursements and encouraging healthcare providers to launch telehealth programs through the DHHS’ Center for Medicare and Medicaid Innovation.
CMS announced that it will extend the deadline for comments on the Request for Information (RFI) seeking input on the design of alternative payment models (APMs) focused on improving the health of children and youth covered by Medicaid and CHIP through April 7.
CMS has issued a final rule which outlines how third party payments are treated when calculating hospital-specific limitation on Medicaid disproportionate share hospital (DSH) payments.
CMS has announced a deadline postponement for certain laboratories to report private payer data for the new laboratory fee schedule. CMS stated the deadline was moved to May 30 due to industry feedback which suggested that many reporting entities would not be able to submit a complete set of applicable information by the initial March 31 deadline.
Florida’s House and Senate budget proposal recommends cuts to the state’s share of Medicaid by $238.6 million drafts. Under the proposed budget, Florida hospitals would see a 7% decrease in the Medicaid reimbursement rate, as well as a decrease in federal matching funds.
The Ohio Department of Medicaid (ODM) and Ohio Department of Mental Health and Addiction Services (OhioMHAS) has announced two major policy and operational updates related to Behavioral Health Redesign. These policy modifications include the expansion of MH Day Treatment service for Qualified Mental Health Specialists (QMHSs) as well as the removal of the limit of 24 hours for Mental Health or SUD Nursing services per patient, per calendar year.
Applicable to the technical component, claims billed with modifier FX to indicate X-ray imaging services were provided using film reduces will be subject to a 20% reduction.
Texas Medicaid requires prior authorization for initial testing of Breast Cancer Gene 1 and 2 (BRCA) as well as prior authorization for genetic testing for colorectal cancer procedure code 81288.
Federal regulation requires State Medicaid agencies to revalidate the enrollment of all providers every five years and ordering/prescribing/referring (OPR) providers who do not comply with this revalidation requirement will be terminated from the Medicaid Program.
An issue has been identified where claims that had TPL insurance coverage as the primary insurance and MaineCare as secondary were paid as primary in error.
CMS issued an interim final rule delaying the implementation date for new bundled payment regulations as well as the effective date of the bundled payment final rule.
The Agency for Health Care Administration is seeking the renewal of two Florida Medicaid Waivers. The proposed extensions hope to renew the Adult Cystic Fibrosis Waiver and the Traumatic Brain and Spinal Cord Injury Waiver for the period July 1, 2017 through June 30, 2022.
The Rutgers University, Center for State Health Policy has released a ‘Year 1’ report of the New Jersey’s Medicaid ACO demonstration, with an assessment of ACO operations and care management strategies.
CMS has granted a broad-based waiver to Vermont which gives the state the authority to initiate an all-payer ACO pilot aimed at serving 30,000 of the state’s 190,000 Medicaid beneficiaries in 2017.
The long-anticipated legislation to repeal and replace the ACA’s core features was unveiled on March 6.
In a letter to CMS and the Office of the National Coordinator for Health Information Technology, MGMA, along with 100 medical organizations, requested a deferment for the required use of 2015 Edition CEHRT in the QPP or Medicaid MU Program. The letter recommends that use of 2015 CEHRT remain voluntary until such technology is widely available, no sooner than January 2019.
An ACA provision mandating providers to revalidate or recertify their Medicaid reimbursement eligibility has resulted in an estimated 65,000 providers dropped from the program.
Vermont has entered into a one year agreement with OneCare to launch an ACO pilot program serving 30,000 Medicaid beneficiaries.
Connecticut Gov. Dannel Malloy, on February 8, proposed a plan aimed at closing the nearly $1.7 billion state budget deficit.