Tagged with Medicare Billing

2018 QPP and MPFS Final Rules Released

CMS has released final rules for the 2018 Medicare Physician Fee Schedule (MPFS) and the Quality Payment Program (QPP). The rules, scheduled to take effect January 1, 2018, address changes within the fee schedule as well as other Medicare Part B payment policies, such as changes to the Medicare Shared Savings Program.

WI – Funding Increase for Mental Health, Substance Abuse Treatment

The Wisconsin Department of Health Services plans to raise Medicaid reimbursement rates for outpatient mental health and substance use disorder services in 2018. The rate change will increase the maximum allowable fee for each covered outpatient services and simplify the rate structure so there are two fees per service rather than five.

MA – Senate Releases Comprehensive Health Care Legislation

Massachusetts Senate leaders have released a comprehensive health care legislation containing a wide range of provisions that, if finalized, would require the state to report the top 50 employers with the highest number of employees who receive coverage through MassHealth as well as require those companies identified to pay a large portion of a $200 million assessment to cover funding shortfalls in the state’s Medicaid program, MassHealth.

CMS Announces Transition of eCQMs to CQL for CY2019 Reporting Periods

CMS, on October 31st, announced that electronic clinical quality measures (eCQMs) in CMS quality programs will be transitioned to use the Clinical Quality Language (CQL) standard (CQL Release 1, Standard for Trial Use (STU) 2) for logic expression. Additionally, CMS has issued revised technical release notes (TRNs) for the addendum to the electronic clinical quality measure (eCQM) annual update specifications for 4th Quarter 2017 reporting and 2018 reporting periods.

CMS Issues Guidance on Information Blocking Prevention in MIPS

CMS has published guidelines detailing requirements as to how Merit-Based Incentive Payment System (MIPS)-eligible clinicians must attest in order to prove they have made a good-faith effort to implement and use EHR technology that supports the timely exchange of healthcare information.

House Votes to Continue CHIP Funding

The U.S. House of Representatives voted 242-174 to reauthorize federal funding to maintain low-cost health insurance to 8.9 million children and 370,000 pregnant women under the Children’s Health Insurance Program (CHIP). The Healthy Kids Act extends CHIP’s federal funding for five years and federally qualified health centers for two years.

IL BCBSIL NDC Billing Update for Medicare Advantage Claims

Effective December 15, Blue Cross and Blue Shield of Illinois (BCBSIL) will implement edits to validate National Drug Code (NDC)s that are submitted on electronic and paper, professional and institutional Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) claims.

Medicare IVIG Demonstration Extended

On September 28, legislation (Public Law No: 115-63) was passed which extends the Medicare Intravenous Immunoglobulin (IVIG) Demonstration through December 31, 2020.

Cigna Medical Policy Updates

Cigna has posted updates to specific medical and preventive care services policies, including its uniform billing editor, pharmacy and infusion services, and omnibus reimbursement.

CMS Issues MIPS Eligible Measure Applicability Resources

CMS has introduced a new MIPS Eligible Measure Applicability process to allow providers who were unable to submit the required number of quality measures the opportunity to earn the maximum score for that reporting category.

2018 eCQM Value Set Addendum for EPs, ECs Released

CMS has released an addendum to the electronic clinical quality measure (eCQM) annual update specifications originally published in May 2017. This addendum updates eCQM value sets for the 2018 performance period for Eligible Professionals (EPs) and Eligible Clinicians (ECs).

Medicare to Offer More Coverage Choices, Decreased Premiums

CMS has announced that people with Medicare will have more choices and options for their Medicare coverage in 2018. The average monthly premium for a Medicare Advantage plan will decrease and enrollment is projected to reach a new all-time high.

FL – 44.7% Proposed PPACA Rate Increase for 2018

Florida state officials have announced submission of the proposed rates for 2018 ACA plans. According to the announcement, premiums may increase by 44.7% next year for ACA compliant plans.

CMS Announces $10M Budget to Promote ACA Open Enrollment

CMS has announced its plans for the Affordable Care Act (ACA) Navigator program and enrollment promotion for the upcoming open enrollment period. The agency says it will spend $10 million on promotional activities in order to meet the needs of new or returning ACA enrollees – 10% of the $100 million spent last year to promote enrollment through digital media, email, and text messages.