Tagged with Medicare Billing

MBI Changes for New Medicare Cards

CMS has posted information regarding the instances in which a Medicare Beneficiary Identifier (MBI) could be subject to change.

CMS Reintroduces QMB Information in Provider RAs and MSNs

CMS has issued a reminder to Medicare providers regarding proper billing for certain beneficiaries enrolled in the Qualified Medicare Beneficiary (QMB) program and also announced the reinstatement of QMB information in provider Remittance Advices (RAs) and Medicare Summary Notices (MSNs).

Laboratory Date of Service Exception Extended

CMS has released a notice stating it will exercise enforcement discretion, through the next year, for the laboratory date of service exception policy for certain laboratory and molecular pathology tests.

CMS Advances Demonstration to Waive MIPS Requirements

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.

CMS Launches New DEL Interoperability Database

CMS has announced the launch of its Data Element Library (DEL), a new free database designed to support the exchange of electronic health information between providers and facilities.

UnitedHealthcare – Coordinated Commercial Reimbursement Policy Updates

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.

Rhode Island – BCBSRI CPT and HCPCS Level II Code Changes

Blue Cross and Blue Shield of Rhode Island (BCBSRI) has updated its claims processing system. These updates became effective April 1 and include Category II performance measurement tracking codes and Category III temporary codes for emerging technology.

New York – State Medicaid EHR Incentive Program Update

The New York Department of Health has released an update regarding its Medicaid Electronic Health Records (EHR) Incentive Program which provides financial incentives to eligible professionals (EPs) and hospitals to promote the transition to EHRs.

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.