Tagged with Medicare Advantage
CMS Introduces New Cost Comparison Tool
In an effort to improve healthcare price transparency, CMS launched a tool that allows consumers to compare Medicare payments and copayments for certain procedures that are performed in both hospital outpatient departments and ambulatory surgical centers.
Humana Updated Claim Payment Policies
Humana recently published new updates to its claim payment policy for pass-through billing as well as its policy for telehealth and telemedicine.
New Proposed Rule Seeks to Streamline Medicaid Managed Care Programs
CMS has released a new proposed rule that would make changes to current Medicaid managed care programs and speed up state managed care contracting processes.
HHS Advances Payment Model to Lower Drug Costs for Patients
HHS has announced a new International Pricing Index (IPI) payment model to reduce what consumers in the United States pay for prescription drugs. Under the new model, Medicare’s payments for select physician-administered drugs would shift to a level more closely aligned with prices in other countries.
New Hampshire State Senator Proposes Bill Targeting Surprise Emergency Room Bills
A New Hampshire senator has announced plans to file legislation that is designed to address surprise medical bills that some patients say keep coming after a visit to the emergency room for an illness or injury.
Medicare Advantage Premiums Expected to Drop Again
According to CMS, Medicare Advantage premiums are expected to decrease by 6% on average in 2019 with membership likely expanding to more than 36% of Medicare beneficiaries.
CMS Announces New Streamlined User Experience for Medicare Beneficiaries
CMS, on October 1, announced a multi-year initiative that will empower patients and update Medicare resources to meet beneficiaries’ expectation of a more personalized customer experience. The eMedicare initiative will modernize the way beneficiaries get information about Medicare and create new ways to help them make the best decisions for themselves and their families.
Wisconsin – Outpatient Injectable Chemotherapy Notification for UHC MA Plans
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 Claim Processing Edits
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 Posts Medicare Part D Opioid Prescribing Mapping Tool Update
CMS has released an updated version of the Medicare Part D opioid prescribing mapping tool.
CMS Expands Definition of “Primarily Health Related” Benefits
CMS has expanded its definition of “primarily health related” benefits which carriers are allowed to include in their Medicare Advantage (MA) policies.
MedPAC Releases 2018 Report
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.
Anthem Blue Cross and Blue Shield Virginia Coverage and Clinical Guideline Update
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.
UnitedHealthcare Redesigns Emergency Department Reimbursement Policy
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 Withdrawal of Modifier 25 Policy
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 Balance Billing Notice for Medicare Beneficiaries
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).
UnitedHealthcare Medicare Advantage Notification for Outpatient Injectable Chemotherapy
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.
Department of Health and Human Services Announces Future Changes to Provider Reimbursements
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.
Senate Budget Deal Includes Program Funding, 10 Year CHIP Extension
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.
Humana Updates Preauthorization and Notification Lists for 2018
On January 22nd, Humana will update its preauthorization and notification lists for all commercial fully insured, Medicare Advantage plans and dual Medicare-Medicaid plans.