Tagged with Provider Contracting and Enrollment
Delaware’s Board of Medicine has issued new guidelines for telehealth and telemedicine, banning phone-based and asynchronous services while permitting virtual care for some specific opioid treatment programs.
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.
Rhode Island officials are requesting an extension of the state’s 1115 demonstration to expand the use of value-based care within the state’s Medicaid program.
CMS is proposing updates and policy changes under the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System.
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.
Anthem’s behavioral health medical policies and clinical guidelines currently in place for reviewing of behavioral health services, will be replaced by the MCG Care Guidelines 22nd edition Behavioral Health guidelines.
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.
Highmark has announced that beginning October 1, eviCore will manage prior authorizations for Highmark members with non-emergent conditions requiring musculoskeletal (MSK) surgery or interventional pain management (IPM) services.
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.
Following review of the CPT and HCPCS, Blue Cross and Blue Shield of Vermont (BCBSVT) has posted several coding, prior approval, investigational services, and unit designation changes.
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.
The governor of Pennsylvania has given final approval for the state’s $32.7 billion 2018-19 spending bill. The finalized bill, House Bill 2121, includes a number of healthcare related provisions, such as increased funding for community-based family centers and home-visiting providers, additional investments to assist individuals with intellectual disabilities and autism, and increased access waivers for in-home supports and services.
CMS has published Open Payments Program Year 2017 data, along with newly submitted and updated payment records for previous program years.
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).
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.
CMS has published the most recent updates to its Quality Data Model (QDM) standard. According to the agency, the latest version has been updated to align with the emerging standard, Health Level Seven International (HL7) Fast Healthcare Interoperability Resources (FHIR) and add increased explicit capabilities.
The House of Representatives has passed a comprehensive piece of legislation specifically designed to help combat opioid use throughout the United States.