Tagged with Provider Contracting and Enrollment

Pennsylvania – FY 2019 Budget Legislation Approved

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.

MBI Changes for New Medicare Cards

CMS has posted information regarding the instances in which a Medicare Beneficiary Identifier (MBI) could be subject to change.

CMS Reintroduces QMB Information in Provider RAs and MSNs

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).

Quality Data Model (QDM) Update Released

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.

CMS Launches New DEL Interoperability Database

CMS has announced the launch of its Data Element Library (DEL), a new free database designed to support the exchange of electronic health information between providers and facilities.

Aetna – Clinical Payment and Coding Policy Changes

Effective September 1, Aetna will implement changes to its clinical payment and coding policy for several services and procedures, and will also implement several changes to its CPT® codes assigned to Enhanced Groupings (AEG) and/or Coventry Enhanced Groupings (CEG).

UnitedHealthcare – Coordinated Commercial Reimbursement Policy Updates

Beginning in July, UnitedHealthcare (UHC) will make changes to some commercial reimbursement policies, including after hours and weekend care, intraoperative neuromonitoring, and its professional and technical component policy for duplicate or repeat services of global test only.

Rhode Island – BCBSRI CPT and HCPCS Level II Code Changes

Blue Cross and Blue Shield of Rhode Island (BCBSRI) has updated its claims processing system. These updates became effective April 1 and include Category II performance measurement tracking codes and Category III temporary codes for emerging technology.