Tagged with Medicare Billing
CMS has granted a broad-based waiver to Vermont which gives the state the authority to initiate an all-payer ACO pilot aimed at serving 30,000 of the state’s 190,000 Medicaid beneficiaries in 2017.
The long-anticipated legislation to repeal and replace the ACA’s core features was unveiled on March 6.
Vermont has entered into a one year agreement with OneCare to launch an ACO pilot program serving 30,000 Medicaid beneficiaries.
The DOJ moves forward with legal action against two insurers accused of erroneous coding and inflated billing – UnitedHealth and WellMed Medical Management.
UnitedHealthcare has announced its now pilot program focused on improving the overall experience of their members.
The Accredited Standards Committee X12, a group which advises on insurer standards, is recommending device identifiers (DIs) be included on medical claims forms.
CMS issued an insurance standards bulletin granting another extension to non-ACA-compliant health plans to allow insurers and consumers to extend for an additional year.
CMS recently announced its new proposed rule aimed at stabilizing ACA markets and encourage more insurers to stay on the exchanges through promoting more coverage options, and improving the risk pool for insurers.
Florida Governor Rick Scott, on January 31st, announced a near $83.5 billion budget for 2017-18.
A new study has identified nine states, along with the District of Columbia, as those responsible for the vast majority of the total improper payments.
In effort to reduce the significant Medicare appeals backlog, CMS finalized regulations for the Medicare Program: Changes to the Medicare Claims and Entitlement, Medicare Advantage Organization Determination, and Medicare Prescription Drug Coverage Determination Appeals Procedures. According to HHS, the final rule streamlines administrative appeal processes, increases consistency in decision making across appeal levels, and improves efficiency for both appellants and adjudicators.
Early last month, the Health Resources and Services Administration (HRSA) published a final rule(pdf) to implement civil money penalty (CMP) provisions added to section 340B of the Public Health Service Act under the Affordable Care Act (ACA).
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) has issued a final rule expanding the authority to exclude individuals and entities from federal health care programs.
CMS has announced proposed changes to the Part D prescription drug program and Medicare Advantage for calendar year 2018.
CMS’ newest Medicaid managed care final rule will prevent increases in pass-through payments as well as the addition of new pass-through payments beyond those in place when the pass-through payment transition periods were established.
Following a 51 to 48 vote in the Senate, House members on January 13 voted 227 to 198 to advance repeal of the Affordable Care Act in a budget resolution bill.
The Medicare Payment Advisory Commission (MedPAC) has approved recommendations calling for health care provider payment increases in FY2018.
CMS has announced a new global capitation model for rural hospitals in Pennsylvania. Under the new model participating critical access hospitals and acute care hospitals will receive all-payer global budgets for a fixed amount of money that is set in advance and funded by all participating insurers, to cover inpatient and outpatient services.
UnitedHealth Group has announced plans for its health services unit, Optum, to acquire Surgical Care Affiliates (SCA). Under the acquisition, Optum would add to its footprint SCA 205 surgical facilities, which SCA operates in partnership with thousands of surgeons in 33 states.
A new study from Harvard Medical School claiming to have found “meaningful” improvements in quality, outcomes, and spending for all patients in the Alternative Quality Contract (AQC) between suggests binding insurers’ physician payments to quality metrics can narrow disparities between low- and higher-income patients.