Tagged with Medical Billing Compliance
NJ – DHS Expands Behavioral Health Benefits Covered Under NJ FamilyCare
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.
CMS Removes Medicare Advantage Sanctions on Cigna
CMS has lifted enrollment and marketing sanctions against Cigna for its Medicare Advantage and prescription drug plans.
TX – House Passes Bill to Allow Virtual Visits
The Texas House of Representatives has passed a bill, by unanimous vote, that will enable physicians licensed in the state to supply telemedicine services to patients they have never met in person.
CMS Announces Change Intended to Streamline Exchange Plan Enrollment
CMS has released guidance stating that it will no longer require U.S. residents enrolling in exchange plans via a direct enrollment pathway to complete the enrollment process on HealthCare.gov.
Transition Period Extended for Compliance with HCBS Criteria
CMS issued an Informational Bulletin providing additional clarity on provisions of the final regulation defining home and community-based service (HCBS) settings. The bulletin indicates that that states may take an additional three years to ensure compliance with criteria of a HCBS setting. The agency says this additional time “will be helpful to states to ensure compliance activities are collaborative, transparent and timely.”
CMS gives over 800K Physicians Reprieve from MACRA Reporting in 2017
CMS has sent over 800,000 letters to clinicians, with notification that they will not be evaluated under the MACRA Merit-based Incentive Payment System (MIPS) in 2017. Federal officials predict only about one-third of clinicians will have to file quality reports this year under the new Medicare payment system.
New Fact Sheet on Administrative Simplification Basics
CMS’ newly released fact sheet explains how Administrative Simplification standards streamline day-to-day tasks such as billing, verifying patient eligibility, sending and receiving payment.
MGMA, AMA Request Delay in 2015 Edition Certified EHR
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.
CT – Governor Proposes Cuts to Medicaid Program
Connecticut Gov. Dannel Malloy, on February 8, proposed a plan aimed at closing the nearly $1.7 billion state budget deficit.
OIG Final Rule Expands Exclusion Authorities
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) has issued a final rule expanding the authority to exclude individuals and entities from federal health care programs.
New Final Rule Targets Pass-Through Payments
CMS’ newest Medicaid managed care final rule will prevent increases in pass-through payments as well as the addition of new pass-through payments beyond those in place when the pass-through payment transition periods were established.
NJ – OIG Report Reveals Improper Medicaid Payments
A report released by the HHS Office of Inspector General (OIG) states, over a four-year span, New Jersey has received an estimated $95 million in improper Medicaid payments. According to the report, “The deficiencies occurred because the state … did not adequately monitor [its] partial care services program to ensure that providers complied with [the program’s] requirements.”
