Tagged with Provider Contracting and Enrollment

FY 2018 Budget Released

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).

CARC and RARC Updates Announced

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.

TX – House Passes Bill to Allow Virtual Visits

The Texas House of Representatives has passed a bill, by unanimous vote, that will enable physicians licensed in the state to supply telemedicine services to patients they have never met in person.

MA – OptumHealth to Acquire Reliant Medical Group

OptumHealth, a subsidiary of UnitedHealthcare, has announced plans to acquire Reliant Medical Group, a physician group out of Massachusetts. The acquisition represents Optum’s first venture into the state’s provider market.

CT – State Insurers Request Rate Increases on Individual and Group Plans

Health insurers in Connecticut have submitted health insurance rate request individual and small group plans in 2018. A total of 10 health insurance companies have made 14 filings on individual and small group plans that provide coverage to approximately 270,000 people in the state. The average rate requests range from 3.6% to 33.8%.

Transition Period Extended for Compliance with HCBS Criteria

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 gives over 800K Physicians Reprieve from MACRA Reporting in 2017

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 Releases Final Market Stabilization Rule

CMS published a final rule intended to help improve the risk pool and stabilize the Affordable Care Act insurance exchanges for 2018. Under the final rule, the 2018 open enrollment period for the individual market is shortened from three months to six-weeks.

Uninsured Rate Swells to 11.3% in Q1

Gallup-Healthways Well-Being Index poll shows uninsured rate increased to 11.3% in the first quarter of 2017 from a record low of 10.9% in the last half of 2016.

Aetna: Payment Reduction for X-Rays Using Film

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.