Tagged with Medicare Advantage
CMS has advancing the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration, which, when approved and adopted, would waive Merit-Based Incentive Payment System (MIPS) requirements for clinicians who participate sufficiently in certain Medicare Advantage plans that involve taking on risk.
Tufts Health Plan has released payment policy updates for the administration of anesthesia for medically necessary services rendered by contracting anesthesiologists in a physician office, inpatient or outpatient facility.
Highmark has announced that beginning October 1, eviCore will manage prior authorizations for Highmark members with non-emergent conditions requiring musculoskeletal (MSK) surgery or interventional pain management (IPM) services.
Humana has updated its Medicare Advantage, Commercial, and Medicaid payment policies for health care services delivered using electronic information and telecommunications technologies.
As of June 1, Aetna will expand its clinical review program and implement pre-approval changes for members in Indiana (IN), Illinois (IL) and Tennessee (TN).
On July 12, CMS published its proposed policy, payment, and quality provisions changes to the Medicare Physician Fee Schedule (MPFS) for Calendar Year (CY) 2019.
Aetna has made changes to its precertification list for certain home health care services for Medicare Advantage members
Beginning in July, UnitedHealthcare (UHC) will make changes to some commercial reimbursement policies, including after hours and weekend care, intraoperative neuromonitoring, and its professional and technical component policy for duplicate or repeat services of global test only.
Effective August 1, Humana will implement changes to the time frame for peer-to-peer review process for its Medicare Advantage (MA) health plans.
Humana has published new and updated medical claims payment policy for certain CPT and diagnosis codes as well as correct coding updates, scheduled to take effect in July.
Blue Cross Blue Shield of Massachusetts (BCBSMA) has released coding and payment updates for certain procedures and services, including venipuncture reported with labs or E&M service, interim caries arresting medicament, and others.
Effective April 1, UnitedHealthcare (UHC) will require care providers to submit a notification for injectable chemotherapy for members located in Wisconsin when it is administrated in an outpatient setting for UHC Medicare Advantage (MA) members with a cancer diagnosis.
Humana has released several claims processing edits, including updates to Outpatient Prospective Payment System (OPPS), Modifiers 96 and 97, HCPCS Drugs & Biologicals, and other policies.
CMS has released an updated version of the Medicare Part D opioid prescribing mapping tool.
CMS has expanded its definition of “primarily health related” benefits which carriers are allowed to include in their Medicare Advantage (MA) policies.
CMS has released the final policy and payment updates to the Medicare Advantage (MA) and Part D programs for 2019. The policy changes for the coming year will include a pay increase for MA plans and strategies to increase the use of encounter data to determine risk scores for plans.
The Medicare Payment Advisory Commission (MedPAC) has released its March 2018 Report to Congress on Medicare payment policy, detailing its payment update recommendations to Congress, which the Commissioners voted on in January.
Effective May 1, Anthem Blue Cross and Blue Shield in Virginia (BCBS VA) will implement new and revised coverage guidelines approved at the most recent quarterly Medical Policy and Technology Assessment Committee meeting.
UnitedHealth Group has announced plans to introduce a new payment policy intended to reduce its emergency department claims cost.
Anthem Blue Cross and Blue Shield (BCBS) has published a notice informing health care professionals and policyholders that the insurer will no longer proceed with the reimbursement policy impacting physician use of payment Modifier 25.