Tagged with Provider Contracting and Enrollment

CMS Announces $10M Budget to Promote ACA Open Enrollment

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.

NY – Department of Health Launches Value Based Payment Learning Resources

The New York Department of Health has launched an on-line learning program: VBP University as an educational resource designed to raise awareness, knowledge and expertise in the move to Value Based Payment (VBP). The program combines informational videos and supplemental materials that look at the state’s VBP Roadmap and its requirements for addressing social determinants of health (SDH).

NJ – State Seeks Input on Reorganization Plan for Mental Health, Addiction Services

New Jersey has launched a six-week outreach effort aimed at aiding staff, providers, and consumers understand the potential benefits and timeline of the state’s Reorganization Plan 001-2017 which would transfer mental health and addiction functions from the Department of Human Services (DHS) to the Department of Health (DOH).

TX – Medicaid Proposes Reimbursement Cuts of at least 10% for Several Specialties

Texas Medicaid has proposed to reduce reimbursement rates by at least 10% for several specialties and services. The newly proposed reimbursement rates would take effect on October 1, impacting such specialties as Ears, Nose, and Throat, Radiation Oncology, Nuclear Medicine, Physician Administered Drugs, Substance Use Disorder Services, Hospital Outpatient Imaging, and Rural Hospital Outpatient Imaging.

UHC – Genetic and Molecular Testing Prior Auth. Requirement

Effective Nov. 1, UnitedHealthcare will start its online prior authorization/notification program for genetic and molecular testing performed in an outpatient setting for fully insured UnitedHealthcare Commercial Plan members. Providers requesting laboratory testing will be required to complete the prior auth. process as well as indicate the laboratory and test name for specific services.

Humana – Cardiology Code Edits

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 Updates Assistant Surgeon Policy and Code List

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.

Medical Liability Reform Bill Passes House

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.

CMS Releases Quality Payment Program Proposed Rule

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).

End-Stage Renal Disease Proposed 2018 Policy and Payment Rate Changes

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.