Tagged with Provider Contracting and Enrollment
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.
CMS has published Open Payments Program Year 2017 data, along with newly submitted and updated payment records for previous program years.
CMS has posted information regarding the instances in which a Medicare Beneficiary Identifier (MBI) could be subject to change.
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).
Medicare will be implementing systems changes in hopes of ensuring that all Part B 837 coordination of benefits/Medicare crossover claims will not include duplicate diagnosis codes.
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.
The House of Representatives has passed a comprehensive piece of legislation specifically designed to help combat opioid use throughout the United States.
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.
The Department of Labor (DOL), on June 18, issued a final rule that will expand consumer availability of association health plans (AHPs) as of September 1, 2018.
Effective July 1, Anthem will implement processing updates for service claims under certain programs, including radiation oncology and cardiology services, which require precertification through AIM Specialty Health® (AIM).
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).
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.
Effective August 1, Humana will implement changes to the time frame for peer-to-peer review process for its Medicare Advantage (MA) health plans.
Humana has published new and updated medical claims payment policy for certain CPT and diagnosis codes as well as correct coding updates, scheduled to take effect in July.
Aetna has released the most recent Current Procedural Terminology® (CPT®) codes added to Aetna Enhanced Grouper (AEG) and/or Coventry Enhanced Grouper (CEG) assignments.
ConnectiCare has released an update to its ambulatory surgical groupers payment policy for revenue codes 360 and 490.
A clarification for the Medicare Beneficiary Identifier (MBI) Look-up Tool has been posted regarding correct mailing and processing of new Medicare cards and MBIs.
CMS has released the latest coding changes, revisions, and feedback to National Coverage Determinations (NCDs) in the 10th revision of the ‘International Classification of Diseases (ICD-10) and Other Coding Revisions.
As of July 1, Anthem Blue Cross and Blue Shield of Wisconsin (BCBSWI) will require unspecified diagnosis codes to only be used when an established diagnosis code does not exist to describe the diagnosis. Reimbursement will be based on review of the unspecified diagnosis code on an individual claim basis.
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.