Tagged with Provider Contracting and Enrollment
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.
Two separate studies investigated why consumers respond to high-deductible plans by using less healthcare services, which in turn leads to a decrease in doctor visits and clinical laboratory test orders.
Texas Medicaid requires prior authorization for initial testing of Breast Cancer Gene 1 and 2 (BRCA) as well as prior authorization for genetic testing for colorectal cancer procedure code 81288.
Federal regulation requires State Medicaid agencies to revalidate the enrollment of all providers every five years and ordering/prescribing/referring (OPR) providers who do not comply with this revalidation requirement will be terminated from the Medicaid Program.
CMS released key deadlines and other important application cycle details information for applying to become a Next Generation ACO or Medicare Shared Savings Program ACO with a 2018 start date.
The U.S. Justice Department recently disclosed that there will be an investigation into four more major health insurers as part of a False Claims Act lawsuit filed against UnitedHealth Group in 2011.
CMS issued an interim final rule delaying the implementation date for new bundled payment regulations as well as the effective date of the bundled payment final rule.
CMS has modified the Medicare claims processing systems to help providers more readily identify the Qualified Medicare Beneficiary (QMB) status of each patient and to support providers’ ability to follow QMB billing requirements. Beneficiaries enrolled in the QMB program are not liable to pay Medicare cost-sharing for all Medicare A/B claims.
CMS will establish two new set-aide processes: a Liability Insurance Medicare Set-Aside Arrangement (LMSA), and a No-Fault Insurance Medicare Set-Aside Arrangement (NFMSA), effective July 2017.
Vermont has entered into a one year agreement with OneCare to launch an ACO pilot program serving 30,000 Medicaid beneficiaries.
Connecticut Gov. Dannel Malloy, on February 8, proposed a plan aimed at closing the nearly $1.7 billion state budget deficit.
A new study reveals insurers with the largest share of local markets can negotiate lower prices for physician office visits.
The Accredited Standards Committee X12, a group which advises on insurer standards, is recommending device identifiers (DIs) be included on medical claims forms.
For the first time since its induction, enrollment numbers in the ACA have gone down.
CMS issued an insurance standards bulletin granting another extension to non-ACA-compliant health plans to allow insurers and consumers to extend for an additional year.
CMS recently announced its new proposed rule aimed at stabilizing ACA markets and encourage more insurers to stay on the exchanges through promoting more coverage options, and improving the risk pool for insurers.
On January 31, Ohio governor, Kasich, unveiled his Executive Budget for 2017 which incorporates a number of Medicaid initiatives, including expanding managed long term services and supports (MLTSS).
Florida Governor Rick Scott, on January 31st, announced a near $83.5 billion budget for 2017-18.
According to the recently released annual report from CMS, in fiscal year 2016 states and federal government grew 4.3% to $575.9 billion and federal Medicaid spending grew 4.5% to $363.4 billion for the program to cover low income and disabled people. The report states Medicaid spending has increased in recent years and is expected to continue to rise, potentially reaching levels that could “displace spending on other important programs.”
Early last month, the Health Resources and Services Administration (HRSA) published a final rule(pdf) to implement civil money penalty (CMP) provisions added to section 340B of the Public Health Service Act under the Affordable Care Act (ACA).