Tagged with Medicare Billing
Effective July 1, Aetna will require prior authorization for certain procedures under its Enhanced Clinical Review Program with eviCore healthcare.
Effective September 1, UnitedHealthcare (UHC) will add a new policy for molecular pathology and will make changes to its procedure to modifier policy.
Beginning July 1, Aetna will require authorization for its enhanced clinical review program with eviCore healthcare for certain outpatient radiation therapy services.
CMS has posted a notice for physicians, hospitals, and other providers billing Medicare Administrative Contractors (MACs) to ensure the payment window edits are bypassed when processing claims for donor post-kidney transplant complications services.
On August 7, CMS finalized the decision to cover Food and Drug Administration (FDA)-approved Chimeric Antigen Receptor T-cell (CAR T-cell) therapy, which is a form of cancer treatment that uses a patient’s own genetically-modified immune cells to fight disease. FDA-approved CAR T-cell therapies are approved to treat some people with specific types of cancer – certain types of non-Hodgkin lymphoma and B-cell precursor acute lymphoblastic leukemia.
CMS announced, on July 2, that it finalized its national coverage policy for Ambulatory Blood Pressure Monitoring (ABPM), extending coverage of blood pressure monitoring devices to all Medicare beneficiaries suspected of reporting abnormal blood pressure levels when administered in clinical settings.
CMS, on June 21, issued several new or updated frequently asked questions documents on the Bundled Payments for Care Improvement (BPCI) Advanced Model, an Advanced Alternative Payment Model launched last October that will run through 2023.
Aetna has released updates regarding how the insurer will handle certain ambulatory surgical center (ASC) and ambulatory payment classification (APC) code edits under the ASC and APC payment methodologies.
Anthem Blue Cross and Blue Shield (Anthem) recently notified members of the upcoming changes to its Anthem Plan Fee Schedules, scheduled to take place July 1.
In a notice to the Office of Management and Budget, CMS requested approval to collect public feedback on possible changes to the Hospital Consumer Assessment of Healthcare Providers and Systems survey (HCAHPS).
In a 7-1 decision, the Supreme Court ruled in favor of the nine hospitals that said the Department of Health and Human Services (HHS) violated the Medicare Act when it changed Medicare’s reimbursement adjustment formula for disproportionate share hospitals without providing notice and opportunity to comment.
CMS has announced the release of a final rule designed to “update and modernize” the Programs of All-Inclusive Care for the Elderly (PACE) program, based upon best practices in caring for frail and elderly individuals.
Senate Health Committee leaders have proposed a legislative health care package which aims to reduce health care costs for individuals by addressing surprise medical bills, drug price transparency, and pharmacy benefit management.
CMS has issued a final rule clarifies changes it has made to the appeals process in the Medicare program for providers, beneficiaries, and suppliers, and streamlines the process for Medicare Parts A and B claims appeals and for Medicare Part D coverage determination appeals.
Aetna has posted updated information regarding how the insurer will handle certain Ambulatory Surgical Center (ASC) and Ambulatory Payment Classification (APC) code edits under the ASC and APC payment methodologies.
CMS, along with the HHS, has announced plans to launch five new Medicare primary pare payment models.
The Promoting Integrity in Medicare Act (PIMA) seeks to update Medicare policies by preventing self-referrals related to advanced imaging services, radiation therapy, anatomic pathology and physical therapy.
CMS proposed a rule that would give the agency earlier notice of a potential sale or merger of an accrediting organization such as the Joint Commission.
The proposal updates Medicare payment policies for hospitals under the Inpatient Prospective Payment System (IPPS) for fiscal year (FY) 2020.
CMS has approved a Florida section 1115 pilot program that provides behavioral health services and temporary housing to Medicaid beneficiaries with severe mental illness and/or substance use disorders.