Tagged with Provider Contracting and Enrollment
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.
Two separate studies investigated why consumers respond to high-deductible plans by using less healthcare services, which in turn leads to a decrease in doctor visits and clinical laboratory test orders.
Texas Medicaid requires prior authorization for initial testing of Breast Cancer Gene 1 and 2 (BRCA) as well as prior authorization for genetic testing for colorectal cancer procedure code 81288.
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.
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.
The U.S. Justice Department recently disclosed that there will be an investigation into four more major health insurers as part of a False Claims Act lawsuit filed against UnitedHealth Group in 2011.
CMS issued an interim final rule delaying the implementation date for new bundled payment regulations as well as the effective date of the bundled payment final rule.
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.
CMS will establish two new set-aide processes: a Liability Insurance Medicare Set-Aside Arrangement (LMSA), and a No-Fault Insurance Medicare Set-Aside Arrangement (NFMSA), effective July 2017.
Vermont has entered into a one year agreement with OneCare to launch an ACO pilot program serving 30,000 Medicaid beneficiaries.
Connecticut Gov. Dannel Malloy, on February 8, proposed a plan aimed at closing the nearly $1.7 billion state budget deficit.