Tagged with Provider Contracting and Enrollment

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.

IN – Request for Medicaid Recipients to Work Could Face Challenges

The Governor of Indiana is seeking permission from CMS to require some Medicaid beneficiaries to be employed or searching for work to be eligible for the Healthy Indiana 2.0 (HIP) plan, but since public comments were not permitted, the state request could be facing some legal challenges.

OH – Budget Passed, Medicaid Freeze Vetoed

On June 28, the Ohio Senate approved the 2018-19 state budget bill in a vote of 24-8. On June 30, Governor John Kasich signed the 2018 state budget into law – vetoing 47 provisions. The Ohio House then voted, on July 6, to override 11 of the 47 line items vetoed.

PA – Legislature Takes Aim at Balance Billing

Pennsylvania legislators have introduced two bills that seek to protect patients from surprise medical bills for both emergency and nonemergency care provided in situations where the patient unknowingly received out-of-network care.

New Medicare Cards to Offer Greater Protection

Increasing efforts toward the prevention of fraud and identity theft, the Medicare Access and CHIP Reauthorization Act (MACRA) mandates that all Social Security numbers be roved from all Medicare cards by April 2019. CMS will begin mailing the new cards with randomly-assigned and unique identifying number in place of the beneficiary’s Social Security number in April 2018.

CMS Releases 1991-2014 Health Care Spending by State

CMS’ Office of the Actuary (OACT) has released its ‘State Health Expenditure Accounts’ report detailing state-level health care spending data for the period 1991-2014. The data reveals large differences of personal healthcare spending from region to region as well as growth in spending in non-expansion states that show similar rates in Medicaid expansion states.

OH – Anthem BCBS to Exit Ohio ACA in 2018

Anthem Blue Cross Blue Shield has announced it will leave the Affordable Care Act market in Ohio in 2018 and will reduce its footprint in the state to one off-exchange product in one county.

IL – Blue Cross Blue Shield Awaits State Review

For the first time since 1990, the Illinois Department of Insurance will conduct a broad market examination of Blue Cross and Blue Shield of Illinois to see how the insurer treats its customers in compliance with consumer protection regulations.

CT – Billing Clarification for Brand Name Medications on the PDL

The Pharmaceutical & Therapeutics (P&T) Committee has modified the list of preferred prescription products. As an aid to providers, Connecticut’s Medical Assistance Program has released clarification on billing requirements for a pharmacy when a brand name medication is dispensed.