Tagged with Provider Contracting and Enrollment

Federal Judge Rules ACA is Unconstitutional

A federal judge in Texas has ruled that the entire Affordable Care Act (ACA) is unconstitutional on the grounds that its mandate requiring people to buy health insurance is unconstitutional and the rest of the law cannot stand without it.

New York – Anthem Reimbursement Policy Updates

Anthem has posted several reimbursement policy updates, including updates to its Rule of Eight” Reporting Guidelines, system updates for 2019, and updates to policy for Modifier 69.

E/M Coding Changes Delayed Until 2021

In the recently published final version of the 2019 Physician Fee Schedule (PFS) and Quality Payment Program (QPP), CMS modifies and delays certain proposed changes to evaluation and management (E/M) codes.

CMS Announces Short-Term IMD Exclusion Waivers for Mental Illness

CMS announced on November 13, a new opportunity for states to seek short-term IMD exclusion waivers, which would allow Medicaid to pay for inpatient mental health services for adults with serious mental illness and children with serious emotional disturbance.

Anthem – Enhanced Automated Claim Edits

Anthem is updating its editing systems to automate edits supported by correct coding guidelines, as documented in industry sources such as CPT®, HCPCS Level II, and ICD-10. Anthem states the enhanced editing automation will promote faster claim processing and reduce follow-up audits and/or record requests for claims not consistent with correct coding guidelines.

Humana Updated Claim Payment Policies

Humana recently published new updates to its claim payment policy for pass-through billing as well as its policy for telehealth and telemedicine.

CMS Releases CY 2019 Physician Fee Schedule Final Rule

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.

CY 2019 OPPS and ASC Payment System Final Rule Released

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 Proposes to Lift Regulations, Ease Provider Burden

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.

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