Tagged with Provider Contracting and Enrollment
AmeriHealth posted a notice in early December, notifying providers and consumers that the insurer’s pathology provider network will be closing for new office-based pathology providers, effective January 1st, 2018.
CMS on January 8th introduced its new voluntary bundled payment model, Bundled Payments for Care Improvement Advanced (BPCI Advanced).
CMS has launched a new data submission system for clinicians participating in the Quality Payment Program (QPP), designed to reduce administrative burdens and streamline the data submission process.
CMS, on December 28th, issued a Survey and Certification Memorandum (S&C Memo) to state survey agencies to clarify and reinforce its position that it prohibits physicians and health care providers from texting orders.
CMS has posted the application fee amount for any enrollment application submitted on or after January 1, 2018 and on or before December 31, 2018.
CMS has finalized proposals to eliminate mandatory hip fracture and cardiac bundled payment models and decrease the scope of the existing Comprehensive Care for Joint Replacement (CJR) bundled payment initiative.
CMS has published the final rule updating Medicare Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgical Center (ASC) Payment System rates and policies for calendar year 2018 (CY 2018).
The Connecticut Department of Social Services (DSS) recently released a memo announcing implementation plans for its process for reviewing claims denied solely due to exceeding the National Correct Coding Initiative (NCCI) Medically Unlikely Edit (MUE) limit for dates of service July 1st, 2016 and forward.
The FDA has approved the first once-monthly injectable buprenorphine product for the treatment of moderate to severe opioid use disorder (OUD) in adult patients who have started treatment with a transmucosal buprenorphine-containing product.
Providers and insurance groups are in favor of CMS’ plans to develop a demonstration project that will test the effects of allowing clinicians to receive credit for financial risk-based arrangements with Medicare Advantage (MA) plans.
CMS Reinforces Rule Prohibiting Billing Dually Eligible Individuals Enrolled in Qualified Medicare Beneficiary Program
CMS has issued a notice to reinforce the rule that Medicare providers and suppliers should not bill beneficiaries enrolled in the Qualified Medicare Beneficiary (QMB) program for Medicare cost-sharing.
CMS has announced premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs for 2018.
For dates of service on or after December 1, 2017, Anthem Blue Cross and Blue Shield (Anthem BCBS) will begin reimbursement for Psychiatric Care Collaborative Management Healthcare Common Procedure Coding System (HCPCS Level II) codes.
Effective for dates of service beginning January 1, 2018, Harvard Pilgrim will cover 3D mammography (digital breast tomosynthesis (DBT)) for screening or diagnostic purposes for members of its Connecticut plans.
Humana has issued several CPT code edits for specialties including Surgery, Pathology, and Radiology.
UnitedHealthcare has released several policy and reimbursement updates that will take effect on December 1, 2017.
The New Jersey Department of Human Services (DHS) last month announced that it has expanded the list of covered health benefits available to align behavioral health coverage for Medicaid Long Term Services and Supports (MLTSS), Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs), and Division of Developmentally Disabled (DDD) MCO members participating in the New Jersey FamilyCare (NJFC) Medicaid managed care program.
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.
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 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.