Tagged with Provider Contracting and Enrollment
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).
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.
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.
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.
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%.
UnitedHealth Group has announced plans to shut down its subsidiary insurance startup which offered unlimited primary and behavioral care at no charge.
Harvard Pilgrim is updating commercial and StrideSM (HMO) Medicare Advantage medical review criteria for the medication infliximab (Remicade/Inflectra) to allow coverage for the CPT code.
CMS has released guidance stating that it will no longer require U.S. residents enrolling in exchange plans via a direct enrollment pathway to complete the enrollment process on HealthCare.gov.
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 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.
The American Health Care Act passed the House of Representatives by 217-213 on May 4.
CMS has named 32 participants to serve as local support for linking clinical and community services in a five-year pilot program under the Center for Medicare and Medicaid Innovation’s Accountable Health Communities model.
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.
Beginning July 1, CMS will require practitioners that are part of a group practice of ten or more that provides global services in certain states to report post-operative visits.
CMS has issued the final market stabilization rule for insurers in the Affordable Care Act market that includes a shortening the open enrollment period for 2018.
CMS’ newly released fact sheet explains how Administrative Simplification standards streamline day-to-day tasks such as billing, verifying patient eligibility, sending and receiving payment.
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.
Starting July 1, Cigna will require prior authorization for physicians prescribing a long-acting opioid that is not being used for cancer treatment, palliative, and end-of-life care.
The Florida House opted to back away from a wide-ranging Medicaid bill proposal that sought to require Medicaid beneficiaries to pay monthly premiums.
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.