Tagged with Medicare Advantage
CMS has announced that it will advance the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration to waive Merit-Based Incentive Payment System (MIPS) requirements for clinicians in certain at-risk Medicare Advantage plans.
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.
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.