Tagged with Medicare Billing
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.
CMS has released a reminder regarding correct billing for recalled cardiac medical in compliance with Medicare requirements for reporting manufacturer credits.
Humana has published a new claim payment policy update for durable medical equipment (DME) repair and replacement.
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.
On November 1, CMS issued the Calendar Year (CY) 2019 Medicare Physician Fee Schedule (PFS) final rule. The final rule updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2019.
CMS has finalized Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) rates and policies for calendar year 2019.
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 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 recently published new updates to its claim payment policy for pass-through billing as well as its policy for telehealth and telemedicine.
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.
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 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.
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 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.
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.
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.
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.
CMS has released its October addenda, providing fourth quarter updates to the ASC payment system.
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, 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.