Tagged with Medicare Billing
The White House has announced that beginning on March 6, Medicare administered by CMS will temporarily pay clinicians to providing virtual visits and other telehealth services to beneficiaries.
CMS has issued a fact sheet detailing existing federal rules governing health coverage provided through the individual and small group insurance markets that apply to the diagnosis and treatment of COVID-19.
CMS is issuing an extension to the 2019 data submission deadline through April 30, 2020. Specifically, the agency is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission.
Effective May 1, UnitedHealthcare (UHC) will deny any non-patient lab test claims submitted by hospital outreach labs if billed under the hospital’s facility participation agreement. The insurer is requiring that hospital outreach labs are credentialed and contracted as an independent reference lab in order to get their non-patient lab test claims paid.
CMS has announced its approval of Florida’s Section 1135 Medicaid waiver request, giving the state greater flexibility to respond to COVID-19. These increased flexibilities include the removal of service barriers; streamlining provider enrollment processes; allowing care to be provided in alternative settings; suspending certain nursing home screening requirements; and extending deadlines for appeals.
Pennsylvania has announced the state’s Medicaid program and Children’s Health Insurance Program (CHIP) will cover COVID-19 testing and treatment for beneficiaries when deemed necessary by a health care practitioner. Additionally, the state says it will also ease some prior authorization requirements to facilitate access to necessary testing and treatment.
Anthem Blue Cross and Anthem Blue Shield (Anthem) has developed a list of frequently asked questions regarding administrative processes and recent changes related to COVID-19.
Aetna has issued a letter to providers detailing the steps the insurer is taking to ensure beneficiaries have access to testing and treatment for COVID-19.
CMS and the Department of Health & Human Services (HHS)’ Office of the National Coordinator for Health Information Technology have released two interoperability rules. The new rules aim to make it easier for patients to access and share their information and aim to end information blocking by requiring public and private entities to securely share health information with patients and penalize those who fail to do so.
CMS’ Center for Medicare and Medicaid Innovation is proposing a three-year extension for the Comprehensive Care for Joint Replacement (CJR) Model. The new rules proposes to change the definition of an episode to include outpatient hip and knee replacements as well as calculation modifications for the basis for the target price.
During the first week in May, the U. S. House and Senate approved an $8.3 billion funding bill to support ongoing efforts to combat COVID-19 (Coronavirus). On March 6, the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (H.R. 6074) was finalized by the president
The U.S. Department of Health & Human Services (HHS) released the final version of its Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs. The strategy aims to reduce clinician burden through incremental changes that will push of electronic health record systems toward interoperability while easing regulatory burden.
The New Hampshire Joint Legislative Committee on Administrative Rules has approved changes to the state’s Medicaid to Schools program, which will allow eligible school districts to be reimbursed for providing health care, rehabilitation, and therapy services for children covered by Medicaid.
Ohio has released the recently revised definition of an Ambulatory Surgical Facility (ASF), as part of the new 2020/2021 general operating budget legislation. The change expanded the ASF definition, which may require some previously unlicensed facilities to obtain licensure.
On February 20, CMS issued a proposed rule which recommends a three-year extension and changes to the episode definition and pricing in the Comprehensive Care for Joint Replacement (CJR) Model.
CMS Administrator, Seema Verma, on February 11, announced the agency’s intent to reform prior authorization regulations later this year. According to Verma, the changes “will reduce administrative waste, increase patient safety and free physicians to spend time caring for their patients.”
On February 13, CMS introduced a new code that enables labs conducting Coronavirus tests to bill for the specific test instead of using an unspecified code.
UnitedHealthcare has announced plans to implement certain changes to enhance the Procedure to Modifier Policy for Medicare Advantage plans to include modifiers CT, FX and FY.
On February 5, CMS released Part II of the Calendar Year (CY) 2021 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies. In the CY 2021 Advance Notice, the agency is proposing updates and changes to the methodologies used to pay MA plans, Programs of All-Inclusive Care for the Elderly (PACE) organizations, and Part D sponsors.
As a guide for physicians, providers, and suppliers billing Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries, CMS has released an update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits. The agency hopes the update will promote national correct coding methodologies and to control improper coding that can lead to inappropriate payment in Part B claims.