Tagged with Medicare Billing
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.
In this legislative session, state lawmakers appear to be emphasizing consumer protections and expanded mandated access to screening exams in bills potentially affecting medical imaging.
MedPAC commissioners have voted in favor of a recommendation that would instruct CMS to use a payment withhold to incentivize Medicare Advantage (MA) plans to submit accurate, complete encounter data and to run MA provider claims through a contractor to ensure encounter data is handled correctly if enough plans don’t submit the data.
The House Ways and Means Committee has unanimously approved drug-pricing legislation that, if passed, would require price transparency from drug makers and pharmacy benefit managers.
CMS has announced the date it will start accepting notices of intent to apply to participate in the overhaul of the Medicare Shared Savings Program (MSSP) – which is now being called ‘Pathways to Success.’
The American College of Radiology (ACR) has released an update to its ACR Appropriateness Criteria.
Cigna has issued several updates to its precertification list for April 2019.
Humana has posted the recent updates to its preauthorization and notification.
New Jersey, Pennsylvania, Rhode Island – UHC Genetic and Molecular Lab Testing Notification Requirement
UnitedHealthcare will soon require providers in New Jersey, Rhode Island, and Pennsylvania to complete the notification/prior authorization process for genetic and molecular testing performed in an outpatient setting.
On April 1, CMS released its finalized payment and policy changes for Medicare Advantage (MA) and Medicare Part D plans for the 2020 coverage year. CMS states the final updates will continue to maximize competition among Medicare Advantage and Part D plans, as well as include important actions to address the nation’s opioid crisis.
CMS has announced plans to analyze whether clinical labs improperly unbundled Medicare billing codes for panel diagnostic tests in order to receive higher payments.
On March 22, the governor of New Jersey has announced that the state will transition from the federally operated Healthcare.gov exchange platform to a state-based exchange by the 2021 plan year. According to state officials, the change will give the state more control over its health insurance market.
The New Hampshire Senate has passed a bill expanding Medicaid coverage for telehealth services. The bill, if finalized, would allow a patient to receive primary care in addition to specialty care via telehealth and enables Medicaid to cover far more connected care services than previously.
A federal judge in Texas has ruled that the entire Affordable Care Act (ACA) is unconstitutional on the grounds that its mandate requiring people to buy health insurance is unconstitutional and the rest of the law cannot stand without it.
CMS has released a reminder regarding correct billing for recalled cardiac medical in compliance with Medicare requirements for reporting manufacturer credits.
Humana has published a new claim payment policy update for durable medical equipment (DME) repair and replacement.