Tagged with Medicare Billing

Anthem Announces Fee Schedule Changes

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.

CMS Looks at Revising HCAHPS Survey

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).

Supreme Court Rules Against HHS in DSH Payment Case

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 Finalizes Rule to Update and Modernize PACE

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.

CMS Finalizes Rule to Streamline Medicare Appeals Process

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.

New Legislation Aims to Strengthen Stark Law

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.

MedPAC Votes to Setup MA Withholds to Improve Encounter Data

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.

2020 ACO Application Timeline Released

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.’