Tagged with Provider Contracting and Enrollment
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.
In 2019, UnitedHealthcare (UHC) will be growing its national network of participating laboratory providers to better support members and the care providers who order laboratory services.
CMS has released a reminder regarding correct billing for recalled cardiac medical in compliance with Medicare requirements for reporting manufacturer credits.
Aetna has issued an update regarding the use of CPT II codes for HEDIS® high blood pressure measurements for patients diagnosed with hypertension.
Anthem has released an update regarding the coding of bundled services for continuous intraoperative neurophysiology monitoring, from outside the operating room.
Aetna has posted a reminder regarding provider contract termination requirements in the state of Connecticut.
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.
Anthem Wisconsin has updated certain medical policies and clinical utilization management (UM) guidelines to support clinical coding edits.
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 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 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 recently published new updates to its claim payment policy for pass-through billing as well as its policy for telehealth and telemedicine.
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.
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 has released a new proposed rule that would make changes to current Medicaid managed care programs and speed up state managed care contracting processes.
New data released by CMS shows 93% of eligible clinicians who participated in the Merit-Based Incentive Payment System (MIPS) under the Quality Payment Program (QPP) received positive payment adjustments for their MIPS performance last year.
The Ohio Department of Medicaid (ODM) has proposed the adoption of a proposed rule which would require two standard authorization forms for the use and disclosure of protected health information (PHI).
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.
The Senate and House each passed a package of 70 bills aimed at addressing the country’s opioid crisis. The package, which has strong bipartisan support, is expected to cost $8.4 billion.
CMS has released its October addenda, providing fourth quarter updates to the ASC payment system.