Tagged with Medicare Advantage

IL BCBSIL NDC Billing Update for Medicare Advantage Claims

Effective December 15, Blue Cross and Blue Shield of Illinois (BCBSIL) will implement edits to validate National Drug Code (NDC)s that are submitted on electronic and paper, professional and institutional Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) claims.

Medicare to Offer More Coverage Choices, Decreased Premiums

CMS has announced that people with Medicare will have more choices and options for their Medicare coverage in 2018. The average monthly premium for a Medicare Advantage plan will decrease and enrollment is projected to reach a new all-time high.

CMS Announces $10M Budget to Promote ACA Open Enrollment

CMS has announced its plans for the Affordable Care Act (ACA) Navigator program and enrollment promotion for the upcoming open enrollment period. The agency says it will spend $10 million on promotional activities in order to meet the needs of new or returning ACA enrollees – 10% of the $100 million spent last year to promote enrollment through digital media, email, and text messages.

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).

Humana and Tenet Agree on New Contract

Humana and Tenet have renewed a multiyear agreement to keep all of Tenet’s U.S. hospitals and outpatient centers in Humana’s coverage network.

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.

Congress to Revisit Telehealth for Chronic Care Legislation

The CHRONIC Care Act of 2017 was reintroduced to Congress this month. The proposed bill targets Medicare payment reform for chronic disease management services and would promote the use of telehealth by eliminating geographic restrictions on telestroke consult services, expand telehealth coverage under MA part B, and give ACOs more flexibility to use telehealth services.

Unitedhealth Posts Strong Earnings Growth in First Quarter

United Healthcare reported first-quarter revenues of $48.7 billion – a 9.4% year-over-year increase from last year. The insurer says that due to 3% insurance tax in Affordable Care Act, plan premiums will likely rise in 2018.

CMS 2018 MA, Part D Final Payment Rates Announced with 0.45% Increase

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.

DOJ v. UnitedHealth

The DOJ moves forward with legal action against two insurers accused of erroneous coding and inflated billing – UnitedHealth and WellMed Medical Management.

Humana to Exit ACA Exchanges by 2018

Humana has announced its plans to cease sales of individual health insurance plans through the ACA’s exchanges by 2018, potentially leaving more than 150,000 customers without a carrier.

CMS Finalizes New Rule to Reduce Medicare Appeals Backlog

In effort to reduce the significant Medicare appeals backlog, CMS finalized regulations for the Medicare Program: Changes to the Medicare Claims and Entitlement, Medicare Advantage Organization Determination, and Medicare Prescription Drug Coverage Determination Appeals Procedures. According to HHS, the final rule streamlines administrative appeal processes, increases consistency in decision making across appeal levels, and improves efficiency for both appellants and adjudicators.

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.