Tagged with Provider Contracting and Enrollment

Aetna: Payment Reduction for X-Rays Using Film

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.

NY – OPR Providers Must Revalidate for Claims to Be Paid

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.

2018 ACO Application Cycle Details Announced

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.

CMS Updates QMB Indicator in Medicare Fee-for-Service Claims Processing System

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.

VT – ACO Pilot Project Announced

Vermont has entered into a one year agreement with OneCare to launch an ACO pilot program serving 30,000 Medicaid beneficiaries.

CMS Issues Non-ACA Compliant Plans Extension

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 Releases Medicaid Spending Report

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.”