Tagged with Medicare Billing
Ways & Means Committee Approves Drug-Pricing Transparency Bill
The House Ways and Means Committee has unanimously approved drug-pricing legislation that, if passed, would require price transparency from drug makers and pharmacy benefit managers.
2020 ACO Application Timeline Released
CMS has announced the date it will start accepting notices of intent to apply to participate in the overhaul of the Medicare Shared Savings Program (MSSP) – which is now being called ‘Pathways to Success.’
Update to ACR Appropriateness Criteria Released to Public
The American College of Radiology (ACR) has released an update to its ACR Appropriateness Criteria.
Cigna Precertification Updates
Cigna has issued several updates to its precertification list for April 2019.
Humana Updates Preauthorization and Notification Lists for 2019
Humana has posted the recent updates to its preauthorization and notification.
New Jersey, Pennsylvania, Rhode Island – UHC Genetic and Molecular Lab Testing Notification Requirement
UnitedHealthcare will soon require providers in New Jersey, Rhode Island, and Pennsylvania to complete the notification/prior authorization process for genetic and molecular testing performed in an outpatient setting.
CMS Releases 2020 Medicare Advantage and Part D Rates
On April 1, CMS released its finalized payment and policy changes for Medicare Advantage (MA) and Medicare Part D plans for the 2020 coverage year. CMS states the final updates will continue to maximize competition among Medicare Advantage and Part D plans, as well as include important actions to address the nation’s opioid crisis.
CMS Takes Aim at Potentially Inappropriate Medicare Lab Test Billing
CMS has announced plans to analyze whether clinical labs improperly unbundled Medicare billing codes for panel diagnostic tests in order to receive higher payments.
New Jersey Will Transition to a State-Based Exchange
On March 22, the governor of New Jersey has announced that the state will transition from the federally operated Healthcare.gov exchange platform to a state-based exchange by the 2021 plan year. According to state officials, the change will give the state more control over its health insurance market.
New Hampshire Senate Passes Medicaid Telehealth Bill
The New Hampshire Senate has passed a bill expanding Medicaid coverage for telehealth services. The bill, if finalized, would allow a patient to receive primary care in addition to specialty care via telehealth and enables Medicaid to cover far more connected care services than previously.
Federal Judge Rules ACA is Unconstitutional
A federal judge in Texas has ruled that the entire Affordable Care Act (ACA) is unconstitutional on the grounds that its mandate requiring people to buy health insurance is unconstitutional and the rest of the law cannot stand without it.
CMS Medicare Billing Reminder for Cardiac Device Credits
CMS has released a reminder regarding correct billing for recalled cardiac medical in compliance with Medicare requirements for reporting manufacturer credits.
Humana Claim Payment Policy Update
Humana has published a new claim payment policy update for durable medical equipment (DME) repair and replacement.
New York – Anthem Reimbursement Policy Updates
Anthem has posted several reimbursement policy updates, including updates to its Rule of Eight” Reporting Guidelines, system updates for 2019, and updates to policy for Modifier 69.
CMS Publishes Final CY 2019 Medicare Physician Fee Schedule Rates and Policies
On November 1, CMS issued the Calendar Year (CY) 2019 Medicare Physician Fee Schedule (PFS) final rule. The final rule updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2019.
CMS Finalizes Medicare OPPS, ASC Rates and Policies for 2019
CMS has finalized Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) rates and policies for calendar year 2019.
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.
CMS Finalizes 2019 Medicare Clinical Lab Payment Determinations
CMS has released its final 2019 Medicare clinical laboratory fee schedule (CLFS) payment determinations for new and reconsidered clinical lab test codes. Specifically, CMS finalized the basis for establishing the payment rate (crosswalking or gapfilling), along with the agency’s rationale for the decision.
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.
CMS Releases CY 2019 Physician Fee Schedule Final Rule
On November 1, CMS released its Medicare Physician Fee Schedule final rule for calendar year (CY) 2019. The latest update includes changes to the Quality Payment Program as well as documentation and payment adjustments for evaluation and management services.
