Tagged with Radiology
Anthem Blue Cross Blue Shield (Anthem) continues to streamline its medical specialty drug reviews by transitioning another drug review process from AIM to Anthem’s medical specialty drug review team. Beginning June 15, for all requests, regardless of service date, providers will need to submit a new prior authorization request by contacting Anthem’s medical specialty drug review team.
The FDA has published two new guidance documents designed to align the agency’s requirements for x-ray imaging devices with various international standards.
In this legislative session, state lawmakers appear to be emphasizing consumer protections and expanded mandated access to screening exams in bills potentially affecting medical imaging.
The FDA announced that it is taking action to “modernize” breast cancer screening in the United States by amending the Mammography Quality Standards Act of 1992 with a new proposed rule.
The American College of Radiology (ACR) has released an update to its ACR Appropriateness Criteria.
Humana has announced plans to launch a value-based oncology program, with the intention to reward providers for more integrated cancer care for Medicare Advantage and commercial members.
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.
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.
Humana has published a new claim payment policy update for durable medical equipment (DME) repair and replacement.
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.
On November 1, CMS issued the Calendar Year (CY) 2019 Medicare Physician Fee Schedule (PFS) final rule. The final rule updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2019.
CMS has finalized Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) rates and policies for calendar year 2019.
In an effort to improve healthcare price transparency, CMS launched a tool that allows consumers to compare Medicare payments and copayments for certain procedures that are performed in both hospital outpatient departments and ambulatory surgical centers.
Delaware Governor recently signed an executive order establishing state health care spending and quality benchmarks beginning in calendar year 2019.
State legislators in Illinois have voted to override the Governor’s veto of a bill intended to place restrictions on short-term health insurance plans sold in in the state, which are exempt from offering certain protections required under the Affordable Care Act (ACA).
CMS has released its final 2019 Medicare clinical laboratory fee schedule (CLFS) payment determinations for new and reconsidered clinical lab test codes. Specifically, CMS finalized the basis for establishing the payment rate (crosswalking or gapfilling), along with the agency’s rationale for the decision.
UnitedHealthcare (UHC) has released its most recent medical policy updates for November 2018 which includes complete details on UHC medical policy, medical benefit drug policy, coverage determination guideline), utilization review guideline, and/or quality of care guideline updates, as well as new, updated, revised, replaced and retired health services policies.