Tagged with Medicare Advantage
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.
Aetna has issued a notice reminding providers and billing professionals that Medicare beneficiaries under the Qualified Medicare Beneficiary (QMB) program should not be billed for cost sharing (balanced billing).
As of March 1 for UnitedHealthcare (UHC) Medicare Advantage (MA) members in Florida and Georgia and April 1 for plans in Wisconsin, UHC will require care providers to submit a notification for injectable chemotherapy when administrated in an outpatient setting for UHC MA members with a cancer diagnosis.
The Department of Health and Human Services (HHS) has announced its plans to overhaul the way the federal government reimburses providers. The Department states, in an effort to improve technology and transparency, it will make changes to interoperability, price transparency, and care delivery through Medicare and Medicaid, and remove regulations that hinder private innovation.
The Senate has reached its two-year budget deal which includes a 10 year extension to CHIP, funding to combat the opioid epidemic, and repeal of the Medicare Independent Payment Advisory Board.
On January 22nd, Humana will update its preauthorization and notification lists for all commercial fully insured, Medicare Advantage plans and dual Medicare-Medicaid plans.
Aetna has made adjustments to five clinical payment, coding policies that will become effective on March 1st.
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.