Tagged with Provider Contracting and Enrollment
Pennsylvania has announced the state’s Medicaid program and Children’s Health Insurance Program (CHIP) will cover COVID-19 testing and treatment for beneficiaries when deemed necessary by a health care practitioner. Additionally, the state says it will also ease some prior authorization requirements to facilitate access to necessary testing and treatment.
CMS and the Department of Health & Human Services (HHS)’ Office of the National Coordinator for Health Information Technology have released two interoperability rules. The new rules aim to make it easier for patients to access and share their information and aim to end information blocking by requiring public and private entities to securely share health information with patients and penalize those who fail to do so.
During the first week in May, the U. S. House and Senate approved an $8.3 billion funding bill to support ongoing efforts to combat COVID-19 (Coronavirus). On March 6, the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (H.R. 6074) was finalized by the president
The U.S. Department of Health & Human Services (HHS) released the final version of its Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs. The strategy aims to reduce clinician burden through incremental changes that will push of electronic health record systems toward interoperability while easing regulatory burden.
The New Hampshire Joint Legislative Committee on Administrative Rules has approved changes to the state’s Medicaid to Schools program, which will allow eligible school districts to be reimbursed for providing health care, rehabilitation, and therapy services for children covered by Medicaid.
Ohio has released the recently revised definition of an Ambulatory Surgical Facility (ASF), as part of the new 2020/2021 general operating budget legislation. The change expanded the ASF definition, which may require some previously unlicensed facilities to obtain licensure.
On February 20, CMS issued a proposed rule which recommends a three-year extension and changes to the episode definition and pricing in the Comprehensive Care for Joint Replacement (CJR) Model.
Effective April 26, Anthem Blue Cross Blue Shield (Anthem) will make changes to its outpatient facility edits for revenue codes, CPT® codes, HCPCS and modifiers. These edits will include changes to appropriate use of various code combinations, such as, procedure code to revenue code, HCPCS to revenue code, type of bill to procedure code, type of bill to HCPCS code, procedure code to modifier, and HCPCS to modifier.
Humana has published new and recently updated claim payment policies, including new policies for inpatient readmission review, modifiers CO and CQ, as well as revisions to the insurer’s chronic care management and principal care management and telehealth services policies.
Anthem Blue Cross and Blue Shield (Anthem) of Connecticut (CT) released certain updates to its Vascular Imaging Clinical Appropriateness Guidelines which includes new and updated language for indication of asymptomatic enlargement by imaging and clarifying surveillance intervals for stable aneurysms.
Beginning May 1, claims that are submitted to Anthem Blue Cross and Blue Shield (Anthem) of Ohio for laboratory services subject to the Clinical Laboratory Improvement Amendments (CLIA) 1988 federal statute and regulations will require additional information to be considered for payment.
CMS Administrator, Seema Verma, on February 11, announced the agency’s intent to reform prior authorization regulations later this year. According to Verma, the changes “will reduce administrative waste, increase patient safety and free physicians to spend time caring for their patients.”
On February 13, CMS introduced a new code that enables labs conducting Coronavirus tests to bill for the specific test instead of using an unspecified code.
UnitedHealthcare has announced plans to implement certain changes to enhance the Procedure to Modifier Policy for Medicare Advantage plans to include modifiers CT, FX and FY.
Cigna has released its latest clinical, reimbursement, and administrative policy updates, which includes policy updates for certain anesthesia services, care integration services, and E & M services.
Effective March 1, Aetna will implement code updates under which individual service codes will be assigned within contract service groupings. Changes to an individual provider’s compensation will depend on the presence or absence of specific service groupings within the contract.
On February 7, the U.S. House Ways and Means Committee released its proposed Consumer Protections Against Surprise Medical Bills Act of 2020. If passed, the proposal would ban balance billing for emergency care, care provided by a nonparticipating provider in a participating facility, and in other circumstances of misinformation. The proposal also includes provisions to establish a dispute resolution process for out-of-network reimbursement disagreements.
On February 5, CMS released Part II of the Calendar Year (CY) 2021 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies. In the CY 2021 Advance Notice, the agency is proposing updates and changes to the methodologies used to pay MA plans, Programs of All-Inclusive Care for the Elderly (PACE) organizations, and Part D sponsors.
On January 30, CMS announced the new Healthy Adult Opportunity (HAO) initiative that it will allow states to limit drug coverage under Medicaid without reducing manufacturer rebate obligations.
CMS, on January 30, published the Fiscal Year (FY) 2022 Skilled Nursing Facility (SNF) Annual Payment Update (APU) table, indicating the data elements the agency will use for FY 2022 SNF Quality Reporting Program APU determinations.