Tagged with Medicare Billing
The White House has released its budget proposal for fiscal year (FY) 2018 and presented it to Congress. Totaling at $4.1 trillion, the proposal requests $69 billion in discretionary budget authority and $1,046 billion in mandatory funding to help the Department of Health and Human Services (HHS).
CMS has delayed the start date of the new bundled payment program for heart attack, cardiac bypass, and hip and femur fracture episodes of care and the new cardiac rehabilitation incentive program. The agency also delayed several conforming changes to the existing Comprehensive Care for Joint Replacement (CJR) model until 2018.
The Senate Finance Committee unanimously passed the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017. The legislation seeks to expand telehealth services to Medicaid populations and has received a favorable score by the Congressional Budget Office.
CMS has announced updates to its Claims Adjustment Reason Code (CARC) and Remittance Advice Remark Code (RARC) policy. The newly revised set of codes provides either supplemental explanation for a monetary adjustment or policy information that generally applies to the monetary adjustment.
Florida House and Senate leaders have agreed to approximately $650 million in cuts to hospital payments through Medicaid. The state plans to cut its share of Medicaid payments by $250 million in the upcoming budget, which reduces federal matching dollars by more than $400 million.
CMS has released guidance stating that it will no longer require U.S. residents enrolling in exchange plans via a direct enrollment pathway to complete the enrollment process on HealthCare.gov.
CMS issued an Informational Bulletin providing additional clarity on provisions of the final regulation defining home and community-based service (HCBS) settings. The bulletin indicates that that states may take an additional three years to ensure compliance with criteria of a HCBS setting. The agency says this additional time “will be helpful to states to ensure compliance activities are collaborative, transparent and timely.”
CMS has sent over 800,000 letters to clinicians, with notification that they will not be evaluated under the MACRA Merit-based Incentive Payment System (MIPS) in 2017. Federal officials predict only about one-third of clinicians will have to file quality reports this year under the new Medicare payment system.
CMS has named 32 participants to serve as local support for linking clinical and community services in a five-year pilot program under the Center for Medicare and Medicaid Innovation’s Accountable Health Communities model.
CMS has released the 2017 list of approved qualified registries. Physician practices may utilize these third-party vendors to report individual or group data for the Quality, Advancing Care Information, and Improvement Activities categories of the Merit-Based Incentive Payment System (MIPS) in order to avoid a -4% penalty and potentially earn a small bonus in 2019.
Beginning July 1, CMS will require practitioners that are part of a group practice of ten or more that provides global services in certain states to report post-operative visits.
CMS has issued FY 2018 proposed rule for Medicare Hospital Inpatient Prospective Payment System and Long Term Acute Care Hospital Prospective Payment System. The proposal hopes to relieve regulatory burdens for providers and encourage transparency, flexibility, and innovation in care delivery.
CMS has issued the final market stabilization rule for insurers in the Affordable Care Act market that includes a shortening the open enrollment period for 2018.
The CHRONIC Care Act of 2017 was reintroduced to Congress this month. The proposed bill targets Medicare payment reform for chronic disease management services and would promote the use of telehealth by eliminating geographic restrictions on telestroke consult services, expand telehealth coverage under MA part B, and give ACOs more flexibility to use telehealth services.
United Healthcare reported first-quarter revenues of $48.7 billion – a 9.4% year-over-year increase from last year. The insurer says that due to 3% insurance tax in Affordable Care Act, plan premiums will likely rise in 2018.
CMS has released 2018 Medicare Advantage and Part D payment rates, announcing a 0.45% average rate increase. According to CMS, the changes made aim at providing benefit flexibility and efficiency which will allow Medicare enrollees to choose the care that best fits their health needs.
The bill hopes to expand existing telehealth services for Medicare patients by improving Medicare reimbursements and encouraging healthcare providers to launch telehealth programs through the DHHS’ Center for Medicare and Medicaid Innovation.
CMS has issued a final rule which outlines how third party payments are treated when calculating hospital-specific limitation on Medicaid disproportionate share hospital (DSH) payments.
CMS has announced a deadline postponement for certain laboratories to report private payer data for the new laboratory fee schedule. CMS stated the deadline was moved to May 30 due to industry feedback which suggested that many reporting entities would not be able to submit a complete set of applicable information by the initial March 31 deadline.
Applicable to the technical component, claims billed with modifier FX to indicate X-ray imaging services were provided using film reduces will be subject to a 20% reduction.