Tagged with Medicare Billing
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 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 published a decision memo finalizing its proposal to cover MRI scans for Medicare beneficiaries with implantable cardiac devices such as pacemakers and cardioverter defibrillators.
CMS has released an updated version of the Medicare Part D opioid prescribing mapping tool.
CMS has announced the deadline extension for providers planning to submit an expression of interest (EOI) for the Low Volume Appeals (LVA) Initiative.
CMS has expanded its definition of “primarily health related” benefits which carriers are allowed to include in their Medicare Advantage (MA) policies.
CMS has issued the Advanced Diagnostic Laboratory Tests (ADLT) application along with detailed guidance for laboratories on the process for requesting ADLT status.
CMS will remove the prior authorization (PA) requirement for certain types of medical equipment that no longer meet standards set forth in a 2015 final rule.
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.
According to a new state report, the state of Maryland has seen reductions in hospital admissions and increased cost savings in the first three years since moving forward with its All-Payer Hospital Model.
UnitedHealth Group has announced plans to introduce a new payment policy intended to reduce its emergency department claims cost.
CMS has issued a reminder to providers regarding overpayment and correct billing for many stem cell transplants incorrectly.
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 Florida Legislature has passed a bill that will institute new restrictions on prescription drugs and increase funding for addiction treatment and prevention.
CMS has issued a notice reminding providers and billing staff of the required condition codes to be used when submitting claims for device replacement procedures resulting from a recall or premature failure.
CMS has announced its new initiative for interoperability, MyHealthEData. The program has been designed to empower patients by giving them control of their healthcare data, and allowing it to follow them through their healthcare journey.