Tagged with Medicare Billing
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.
CMS Waives Provider Screening Requirements in Texas and Louisiana During Hurricane Harvey Recovery Efforts
CMS has announced it will suspend certain Medicare enrollment screening requirements for healthcare providers and suppliers that are assisting with Hurricane Harvey recovery efforts in Texas and Louisiana.
The Senate’s Appropriations Committee has approved its fiscal 2018 bill for Department of Health and Human Services (HHS) funding. The bill provides $36.1 billion for National Institutes of Health (NIH), as well as allocates monies for research on Alzheimer’s disease, the Brain Research through Advancing Innovative Neurotechnologies Initiative®, and the Precision Medicine Initiative’s (PMI’s) All of Us Research Program.
Humana released three Cardiology code edits that will be effective as of August 31, as well as significant revisions to certain medical coverage policies.
Anthem Blue Cross and Blue Shield released updated medical policies and clinical guidelines to be implemented on November 1, 2017 in certain states.
CMS has released its second set of frequently asked questions (FAQ) and answers to the Medicaid and CHIP Managed Care Final Rule covering payments to managed care organizations (MCOs) and prepaid inpatient health plans (PIHPs) for patients in an institutional setting for mental disease (IMD).
CMS has issued a proposed rule to cancel the mandatory Episode Payment Models and Cardiac Rehabilitation Incentive payment model, and make changes to the Comprehensive Care for Joint Replacement Model.
Anthem has posted its updated Assistant Surgeon policy and code list to reflect CPT® and Healthcare Common Procedure Coding System (HCPCS Level II) coding changes for 2017 as well as updates based on American College of Surgeons (ACS) and CMS information.
CMS Releases Proposed 2018 Medicare Physician Fee Schedule (MPFS) and Outpatient Prospective Payment System (OPPS)
CMS has released two proposed rules regarding Medicare reimbursement and requirements. The 2018 Proposed Medicare Physician Fee Schedule (MPFS) Proposed Rule addresses Medicare payment and quality provisions for physicians in 2018 and the 2018 Proposed Update to the Outpatient Prospective Payment System (OPPS) will update the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program.
In a vote of 218-210, the Protecting Access to Care Act of 2017 (H.R. 1215) has passed the House of Representatives and will now advance to the Senate for consideration.
On June 20th, CMS released its 2018 Medicare Quality Payment Program (QPP) proposed rule. Officially titled, “CY 2018 Updates to the Quality Payment Program,” the rule includes key policy updates that seek to streamline reporting requirements and simplify participation under the Merit-Based Incentive Payment System (MIPS) [Track 1] and the Advanced Alternative Payment Model (Advanced APM) [Track 2] pathways created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
CMS has issued a proposed rule that would update payment policies for the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS). The ESRD PPS proposed rule is one of several for CY 2018 that reflect a broader strategy to relieve regulatory burdens for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility, and innovation in the delivery of care.
CMS has posted new resources on the Quality Payment Program website to help clinicians successfully participate in the first year of the Merit-based Incentive Payment System (MIPS).
The Governor of Indiana is seeking permission from CMS to require some Medicaid beneficiaries to be employed or searching for work to be eligible for the Healthy Indiana 2.0 (HIP) plan, but since public comments were not permitted, the state request could be facing some legal challenges.
Massachusetts lawmakers recently approved an annual budget, in a 140-9 House vote, that will incorporate fees on businesses to be used to cover the state’s ever-rising health care costs.
Increasing efforts toward the prevention of fraud and identity theft, the Medicare Access and CHIP Reauthorization Act (MACRA) mandates that all Social Security numbers be roved from all Medicare cards by April 2019. CMS will begin mailing the new cards with randomly-assigned and unique identifying number in place of the beneficiary’s Social Security number in April 2018.
CMS’ Office of the Actuary (OACT) has released its ‘State Health Expenditure Accounts’ report detailing state-level health care spending data for the period 1991-2014. The data reveals large differences of personal healthcare spending from region to region as well as growth in spending in non-expansion states that show similar rates in Medicaid expansion states.
Medicare has temporarily changed its rules to offer a reprieve from penalizing consumers who may have missed deadline to enroll in Medicare and kept ACA policies after becoming eligible for Medicare.
The second-largest insurer in the New Hampshire Affordable Care Act (ACA) market has requested average rate hikes of 30% for 2018, citing Medicaid expansion and federally imposed risk adjustments as the cause for the request.
MassHealth has adjusted Medicare Crossover claims billed with certain procedure codes and dates of service.