Tagged with Medicare Billing

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.

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 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.

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.

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.

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.

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.

AdvantEdge