Tagged with Medicare Advantage
CMS has released Part One of the 2019 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part D Payment Policies, containing proposed changes to the Part C Risk Adjustment Model and the use of encounter data.
UHC has announced two updates for notification and prior authorization on certain procedures, as well as revisions to its emergency department facility evaluation and management (e/m) coding policies.
On March 1, 2018, UnitedHealthcare MA will require notification for injectable outpatient chemotherapy drugs given for a cancer diagnosis for members in Florida and Georgia.
Starting in 2018, more claim payments and remittance advice issued to Anthem providers will be made on a weekly basis.
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.
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 and the Cleveland Clinic have created two $0 premium Medicare Advantage health plans for people with Medicare in Cuyahoga County, intended to improve experience and care by providing affordable access patient-focused expert doctors, nurses and facilities.
Humana and Community Care Physicians (CCP) in New York have signed a value-based agreement that will allow in-network access to Humana’s Medicare Advantage members at CCP facilities.
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.
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 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.
Anthem Blue Cross and Blue Shield released updated medical policies and clinical guidelines to be implemented on November 1, 2017 in certain states.
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 have renewed a multiyear agreement to keep all of Tenet’s U.S. hospitals and outpatient centers in Humana’s coverage network.
CMS has lifted enrollment and marketing sanctions against Cigna for its Medicare Advantage and prescription drug plans.
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.
Harvard Pilgrim is updating commercial and StrideSM (HMO) Medicare Advantage medical review criteria for the medication infliximab (Remicade/Inflectra) to allow coverage for the CPT code.