Tagged with Provider Contracting and Enrollment

OH – State Review Panel Releases Medicaid Funds

The Ohio Controlling Board voted unanimously to continue funding for the state’s Medicaid Program, releasing $264 million in state funding needed to qualify for $638 million in federal matching funds.

MA – Senate Releases Comprehensive Health Care Legislation

Massachusetts Senate leaders have released a comprehensive health care legislation containing a wide range of provisions that, if finalized, would require the state to report the top 50 employers with the highest number of employees who receive coverage through MassHealth as well as require those companies identified to pay a large portion of a $200 million assessment to cover funding shortfalls in the state’s Medicaid program, MassHealth.

CMS Issues Guidance on Information Blocking Prevention in MIPS

CMS has published guidelines detailing requirements as to how Merit-Based Incentive Payment System (MIPS)-eligible clinicians must attest in order to prove they have made a good-faith effort to implement and use EHR technology that supports the timely exchange of healthcare information.

IL BCBSIL NDC Billing Update for Medicare Advantage Claims

Effective December 15, Blue Cross and Blue Shield of Illinois (BCBSIL) will implement edits to validate National Drug Code (NDC)s that are submitted on electronic and paper, professional and institutional Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) claims.

Aetna Clinical Payment, Coding and Policy Updates

Aetna has released updated clinical, payment and coding policy positions, including correct coding of hospital observation, critical care, admission and discharge services, changes to the assistant surgeon list and the pass-through billing policy.

Cigna Medical Policy Updates

Cigna has posted updates to specific medical and preventive care services policies, including its uniform billing editor, pharmacy and infusion services, and omnibus reimbursement.

CMS Issues MIPS Eligible Measure Applicability Resources

CMS has introduced a new MIPS Eligible Measure Applicability process to allow providers who were unable to submit the required number of quality measures the opportunity to earn the maximum score for that reporting category.

Medicare to Offer More Coverage Choices, Decreased Premiums

CMS has announced that people with Medicare will have more choices and options for their Medicare coverage in 2018. The average monthly premium for a Medicare Advantage plan will decrease and enrollment is projected to reach a new all-time high.

VA Issues Proposed Rule to Allow Telemedicine Across State Lines

The US Department of Veterans Affairs (VA) has proposed a rule that would preempt state laws restricting the ability of VA healthcare providers to supply telehealth services to veterans across state lines or within states, intended to increase the availability of mental health, specialty care, and general clinical care to veterans, especially in rural areas.

FL – 44.7% Proposed PPACA Rate Increase for 2018

Florida state officials have announced submission of the proposed rates for 2018 ACA plans. According to the announcement, premiums may increase by 44.7% next year for ACA compliant plans.