Tagged with Medicare Billing

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.

Illinois Medicaid Program Expands Telehealth Reimbursement to Increase Access to Behavioral Health and Other Critical Services

Illinois has passed a series of bills that meaningfully expand the reimbursement of telehealth services delivered to its Medicaid patients. Illinois’ legislators, telemedicine advocates, healthcare providers and patient advocacy groups collaborated in an impressive effort to develop focused and targeted legislative solutions that effectively balance the need to get critical behavioral health services to patients in need with long-standing concerns that increasing access via telehealth will result in greater health care costs to a state already experiencing severe financial challenges.

New Jersey Medicaid Issues Telehealth Coverage and Reimbursement Guidance

October 2018 ~ The New Jersey Department of Human Services, Division of Medical Assistance and Health Services (DMAHS) issued a newsletter to NJ FamilyCare (NJFC) providers to clarify the requirements for the provision and billing of NJFC services via telehealth and telemedicine. The guidance comes as a follow-up to the New Jersey Telemedicine and Telehealth…

CMS Issues Billing Reminder for Stem Cell Transplants

CMS has posted a reminder to physicians regarding correcting billing for stem cell transplants following an Office of the Inspector General (OIG) report which found that a large number of providers billed incorrectly for inpatient and outpatient services.

Florida Blue Billing Laterality Modifiers

Florida Blue issued a notice to providers stating the insurer will implement edits for several spinal surgery procedures when billed in conjunction with lumber spinal fusion codes, including spinal cord decompression and laminectomy, facetectomy and foraminotomy procedures.

Humana Claim Processing Edits

Humana has released several claims processing edits, including updates to Outpatient Prospective Payment System (OPPS), Modifiers 96 and 97, HCPCS Drugs & Biologicals, and other policies.

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