Tagged with Provider Contracting and Enrollment
On November 1, CMS released its Medicare Physician Fee Schedule final rule for calendar year (CY) 2019. The latest update includes changes to the Quality Payment Program as well as documentation and payment adjustments for evaluation and management services.
CMS has released its Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule for the next calendar year. According to the agency, the policies adopted in the CY 2019 final rule will help lay the foundation for a patient-driven healthcare system and will also strengthen the Medicare program by providing more choices and lower cost options.
CMS has released a new proposed rule that would make changes to current Medicaid managed care programs and speed up state managed care contracting processes.
New data released by CMS shows 93% of eligible clinicians who participated in the Merit-Based Incentive Payment System (MIPS) under the Quality Payment Program (QPP) received positive payment adjustments for their MIPS performance last year.
The Ohio Department of Medicaid (ODM) has proposed the adoption of a proposed rule which would require two standard authorization forms for the use and disclosure of protected health information (PHI).
Last month, CMS released a proposed rule to remove some of the Medicare participation requirements currently in place for health care facilities. According to the press release, the agency estimates that policies from the proposed rule could potential save hospitals and other facilities approximately $1.12 billion annually.
The Senate and House each passed a package of 70 bills aimed at addressing the country’s opioid crisis. The package, which has strong bipartisan support, is expected to cost $8.4 billion.
CMS has released its October addenda, providing fourth quarter updates to the ASC payment system.
According to CMS, Medicare Advantage premiums are expected to decrease by 6% on average in 2019 with membership likely expanding to more than 36% of Medicare beneficiaries.
CMS, on October 1, announced a multi-year initiative that will empower patients and update Medicare resources to meet beneficiaries’ expectation of a more personalized customer experience. The eMedicare initiative will modernize the way beneficiaries get information about Medicare and create new ways to help them make the best decisions for themselves and their families.
Illinois Medicaid Program Expands Telehealth Reimbursement to Increase Access to Behavioral Health and Other Critical Services
Illinois has passed a series of bills that meaningfully expand the reimbursement of telehealth services delivered to its Medicaid patients. Illinois’ legislators, telemedicine advocates, healthcare providers and patient advocacy groups collaborated in an impressive effort to develop focused and targeted legislative solutions that effectively balance the need to get critical behavioral health services to patients in need with long-standing concerns that increasing access via telehealth will result in greater health care costs to a state already experiencing severe financial challenges.
October 2018 ~ The New Jersey Department of Human Services, Division of Medical Assistance and Health Services (DMAHS) issued a newsletter to NJ FamilyCare (NJFC) providers to clarify the requirements for the provision and billing of NJFC services via telehealth and telemedicine. The guidance comes as a follow-up to the New Jersey Telemedicine and Telehealth…
CMS and the National Library of Medicine (NLM) has published the most recent updates to the electronic clinical quality measure (eCQM) value sets. The updated sets include ICD-10 Clinical Modification (CM) and Procedure Coding System (PCS), SNOMED CT, LOINC, and RxNorm.
Following the release of final scores for the 2017 Merit-based Incentive Payment System (MIPS) performance period and a targeted review period, CMS identified several errors in the final score calculation process. The agency corrected the errors and has recalculated the MIPS final scores and any accompanying payment adjustments for affected physicians.
CMS has posted a reminder to physicians regarding correcting billing for stem cell transplants following an Office of the Inspector General (OIG) report which found that a large number of providers billed incorrectly for inpatient and outpatient services.
Aetna has released its most recent updates to its National Precertification List (NPL), as well as several clinical payment and coding policy changes set to take effect over the coming months.
Anthem BCBS Connecticut has updated several of its reimbursement policies, including OBGYN policies, and language changes to professional reimbursement policies.
Highmark Delaware has identified certain procedure codes that will not be eligible for separate reimbursement and has issued a new policy -with a list of applicable procedure- scheduled to take effect as of December 1.
Florida Blue issued a notice to providers stating the insurer will implement edits for several spinal surgery procedures when billed in conjunction with lumber spinal fusion codes, including spinal cord decompression and laminectomy, facetectomy and foraminotomy procedures.
Effective April 1, UnitedHealthcare (UHC) will require care providers to submit a notification for injectable chemotherapy for members located in Wisconsin when it is administrated in an outpatient setting for UHC Medicare Advantage (MA) members with a cancer diagnosis.