Tagged with Medicare Advantage
On January 6, CMS released Part I of its annual Advance Notice of Methodological Changes for calendar year (CY) 2021. The proposed updates include changes to the Part C CMS Hierarchical Condition Categories (HCC) risk adjustment model as well as proposed changes to how risk scores are calculated for Medicare Advantage (MA) payment.
Humana has published its latest medical claims payment policy updates, including its reimbursement policy for ambulance transportation, requirements for billing and documentation of observation services, as well as a new policy for obstetric billing, including antepartum, delivery and postpartum care.
The president, on October 3, signed an executive order directing the Department of Health and Human Services to increase efforts to provide more insurance plan options under Medicare Advantage and to remove regulations that are considered burdensome to health care providers. The order is intended to protect traditional Medicare and private Medicare Advantage while ramping up alternative payment models, time spent with patients, access to innovative technology and reducing the regulatory burdens on providers.
Effective July 1, Aetna will require prior authorization for certain procedures under its Enhanced Clinical Review Program with eviCore healthcare.
Beginning July 1, Aetna will require authorization for its enhanced clinical review program with eviCore healthcare for certain outpatient radiation therapy services.
Anthem Blue Cross and Blue Shield (Anthem) recently notified members of the upcoming changes to its Anthem Plan Fee Schedules, scheduled to take place July 1.
CMS, along with the HHS, has announced plans to launch five new Medicare primary pare payment models.
Humana has announced plans to launch a value-based oncology program, with the intention to reward providers for more integrated cancer care for Medicare Advantage and commercial members.
Humana has posted the recent updates to its preauthorization and notification.
WellCare Health Plans announced that it will offer Medicaid managed care, Child Health Plus, and Essential Plan coverage in three more New York counties, after receiving approval from state regulators.
New Jersey, Pennsylvania, Rhode Island – UHC Genetic and Molecular Lab Testing Notification Requirement
UnitedHealthcare will soon require providers in New Jersey, Rhode Island, and Pennsylvania to complete the notification/prior authorization process for genetic and molecular testing performed in an outpatient setting.
On April 1, CMS released its finalized payment and policy changes for Medicare Advantage (MA) and Medicare Part D plans for the 2020 coverage year. CMS states the final updates will continue to maximize competition among Medicare Advantage and Part D plans, as well as include important actions to address the nation’s opioid crisis.
Humana has published a new claim payment policy update for durable medical equipment (DME) repair and replacement.
In an effort to improve healthcare price transparency, CMS launched a tool that allows consumers to compare Medicare payments and copayments for certain procedures that are performed in both hospital outpatient departments and ambulatory surgical centers.
Humana recently published new updates to its claim payment policy for pass-through billing as well as its policy for telehealth and telemedicine.
CMS has released a new proposed rule that would make changes to current Medicaid managed care programs and speed up state managed care contracting processes.
HHS has announced a new International Pricing Index (IPI) payment model to reduce what consumers in the United States pay for prescription drugs. Under the new model, Medicare’s payments for select physician-administered drugs would shift to a level more closely aligned with prices in other countries.
A New Hampshire senator has announced plans to file legislation that is designed to address surprise medical bills that some patients say keep coming after a visit to the emergency room for an illness or injury.
According to CMS, Medicare Advantage premiums are expected to decrease by 6% on average in 2019 with membership likely expanding to more than 36% of Medicare beneficiaries.
CMS, on October 1, announced a multi-year initiative that will empower patients and update Medicare resources to meet beneficiaries’ expectation of a more personalized customer experience. The eMedicare initiative will modernize the way beneficiaries get information about Medicare and create new ways to help them make the best decisions for themselves and their families.