Tagged with Medicare Billing
CY 2019 OPPS and ASC Payment System Final Rule Released
CMS has released its Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule for the next calendar year. According to the agency, the policies adopted in the CY 2019 final rule will help lay the foundation for a patient-driven healthcare system and will also strengthen the Medicare program by providing more choices and lower cost options.
CMS Updates Policies and Payment Rates for ESRD/DME NPRM, DMEPOS
CMS has issued a final rule that updates payment policies and rates for Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) and the End-Stage Renal Disease (ESRD) programs.
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.
CMS Proposes to Lift Regulations, Ease Provider Burden
Last month, CMS released a proposed rule to remove some of the Medicare participation requirements currently in place for health care facilities. According to the press release, the agency estimates that policies from the proposed rule could potential save hospitals and other facilities approximately $1.12 billion annually.
Senate, House Pass Major Opioid Legislation Package
The Senate and House each passed a package of 70 bills aimed at addressing the country’s opioid crisis. The package, which has strong bipartisan support, is expected to cost $8.4 billion.
Fourth Quarter ASC Payment Rate Updates Released
CMS has released its October addenda, providing fourth quarter updates to the ASC payment system.
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.
Illinois Medicaid Program Expands Telehealth Reimbursement to Increase Access to Behavioral Health and Other Critical Services
Illinois has passed a series of bills that meaningfully expand the reimbursement of telehealth services delivered to its Medicaid patients. Illinois’ legislators, telemedicine advocates, healthcare providers and patient advocacy groups collaborated in an impressive effort to develop focused and targeted legislative solutions that effectively balance the need to get critical behavioral health services to patients in need with long-standing concerns that increasing access via telehealth will result in greater health care costs to a state already experiencing severe financial challenges.
New Jersey Medicaid Issues Telehealth Coverage and Reimbursement Guidance
October 2018 ~ The New Jersey Department of Human Services, Division of Medical Assistance and Health Services (DMAHS) issued a newsletter to NJ FamilyCare (NJFC) providers to clarify the requirements for the provision and billing of NJFC services via telehealth and telemedicine. The guidance comes as a follow-up to the New Jersey Telemedicine and Telehealth…
eCQM Value Set Update for 2019 Reporting and Performance Periods Published
CMS and the National Library of Medicine (NLM) has published the most recent updates to the electronic clinical quality measure (eCQM) value sets. The updated sets include ICD-10 Clinical Modification (CM) and Procedure Coding System (PCS), SNOMED CT, LOINC, and RxNorm.
CMS Issues Billing Reminder for Stem Cell Transplants
CMS has posted a reminder to physicians regarding correcting billing for stem cell transplants following an Office of the Inspector General (OIG) report which found that a large number of providers billed incorrectly for inpatient and outpatient services.
Florida Blue Billing Laterality Modifiers
Florida Blue issued a notice to providers stating the insurer will implement edits for several spinal surgery procedures when billed in conjunction with lumber spinal fusion codes, including spinal cord decompression and laminectomy, facetectomy and foraminotomy procedures.
Connecticut, New Jersey, New York – Specialty Pharmacy Requirements for Certain Specialty Medications
UnitedHealthcare (UHC) will soon require Oxford Health Plan Commercial Members, participating hospitals in New York, New Jersey and Connecticut to purchase certain medications from a specialty pharmacy.
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 Extends Low Volume Appeals (LVA) Initiative Deadline
CMS has announced the deadline extension for providers planning to submit an expression of interest (EOI) for the Low Volume Appeals (LVA) Initiative.
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.
