Tagged with Medicare Billing
CMS posted a final rule that reissues, with additional explanation, the risk adjustment methodology that CMS previously established for transfers, charges, and making of payments related to the 2017 benefit year.
CMS has published an updated 2018 CMS Quality Reporting Document Architecture Category III (QRDA III) Implementation Guide (IG) for Eligible Clinicians and Eligible Professionals (EPs). The update includes renaming of the Merit-based Incentive Payment System (MIPS) Advancing Care Information performance category, as well as changes to the MIPS performance period reporting.
Virginia has launched a pioneer program to connect all hospital emergency departments (EDs) across one state. The first of its kind in the United States, the Virginia Emergency Department Care Coordination (EDCC) Program will facilitate real-time communication and collaboration among health care providers, health plans, clinical and care management personnel for patients receiving services in Emergency Departments.
CMS has announced plans to publish an addendum to the electronic clinical quality measure (eCQM) value sets to align with the most recent releases to terminologies.
CMS has issued a rule finalizing 2019 updates to Medicare payment policies and rates for the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) and to the IPF Quality Reporting (IPFQR) Program.
CMS is proposing updates and policy changes under the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System.
CMS has advancing the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration, which, when approved and adopted, would waive Merit-Based Incentive Payment System (MIPS) requirements for clinicians who participate sufficiently in certain Medicare Advantage plans that involve taking on risk.
Tufts Health Plan has released payment policy updates for the administration of anesthesia for medically necessary services rendered by contracting anesthesiologists in a physician office, inpatient or outpatient facility.
CMS’ Medicare Physician Fee Schedule (MPFS) proposal for Calendar Year (CY) 2019 includes blended rates for E/M services for levels 2-5, as well as two additional methods to document services.
The changes in CMS’ proposed Medicare Physician Fee Schedule (PFS) for 2019 include an increase to the technical component for certain CPT codes, as well as a proposed decrease for professional interpretation.
Humana has updated its Medicare Advantage, Commercial, and Medicaid payment policies for health care services delivered using electronic information and telecommunications technologies.
UnitedHealthcare (UHC) has updated its advance notification/prior authorization requirements for several services and procedures, as well as three specialty medications, effective July 1.
Connecticare has posted updated documents for in-office laboratory and radiology procedures and announced the removal of advanced radiology procedures from said documents.
On July 12, CMS published its proposed policy, payment, and quality provisions changes to the Medicare Physician Fee Schedule (MPFS) for Calendar Year (CY) 2019.
CMS has posted information regarding the instances in which a Medicare Beneficiary Identifier (MBI) could be subject to change.
CMS has issued a reminder to Medicare providers regarding proper billing for certain beneficiaries enrolled in the Qualified Medicare Beneficiary (QMB) program and also announced the reinstatement of QMB information in provider Remittance Advices (RAs) and Medicare Summary Notices (MSNs).
CMS has released a notice stating it will exercise enforcement discretion, through the next year, for the laboratory date of service exception policy for certain laboratory and molecular pathology tests.
Medicare will be implementing systems changes in hopes of ensuring that all Part B 837 coordination of benefits/Medicare crossover claims will not include duplicate diagnosis codes.
The House of Representatives has passed a comprehensive piece of legislation specifically designed to help combat opioid use throughout the United States.
CMS has announced the launch of its Data Element Library (DEL), a new free database designed to support the exchange of electronic health information between providers and facilities.