Tagged with Specialist Medical Billing
Aetna Issues New Radiation Therapy Preapproval Requirements
Beginning July 1, Aetna will require authorization for its enhanced clinical review program with eviCore healthcare for certain outpatient radiation therapy services.
CMS Notice on Bypassing Payment Window Edits for Donor Post-Kidney Transplant Complication Services
CMS has posted a notice for physicians, hospitals, and other providers billing Medicare Administrative Contractors (MACs) to ensure the payment window edits are bypassed when processing claims for donor post-kidney transplant complications services.
CAR T-Cell Cancer Therapy Available to Medicare Beneficiaries Nationwide
On August 7, CMS finalized the decision to cover Food and Drug Administration (FDA)-approved Chimeric Antigen Receptor T-cell (CAR T-cell) therapy, which is a form of cancer treatment that uses a patient’s own genetically-modified immune cells to fight disease. FDA-approved CAR T-cell therapies are approved to treat some people with specific types of cancer – certain types of non-Hodgkin lymphoma and B-cell precursor acute lymphoblastic leukemia.
CMS Issues Renewed Guidance to Ensure Medicaid Program Integrity
On June 20, CMS released a renewed guidance to state Medicaid agencies that outlines the necessary assurances that states should make to ensure that program resources are reserved for those who meet eligibility requirements.
CMS Releases 2018 ACA Risk-Adjustment Data
CMS, on June 28, released its report summary of the Affordable Care Act (ACA) risk adjustment program for the 2018 benefit year. The analysis found that 572 health insurers offering ACA plans participated in the program in 2018, and transfers between the companies totaled $10.4 billion.
CMS Expands Medicare Coverage of Ambulatory Blood Pressure Monitoring
CMS announced, on July 2, that it finalized its national coverage policy for Ambulatory Blood Pressure Monitoring (ABPM), extending coverage of blood pressure monitoring devices to all Medicare beneficiaries suspected of reporting abnormal blood pressure levels when administered in clinical settings.
CMS Issues FAQs on BPCI Advanced Model
CMS, on June 21, issued several new or updated frequently asked questions documents on the Bundled Payments for Care Improvement (BPCI) Advanced Model, an Advanced Alternative Payment Model launched last October that will run through 2023.
CMS Re-issues Memo to Providers about Emergency ‘Born-Alive’ Infants’ Rules
The CMS has re-issued a memorandum on emergency stabilization and treatment of newborn infants that could cause fresh anxiety for hospitals and physicians over abortion and care for pregnant women and severely disabled infants.
New Jersey Approves Legislation to Increase HMO Annual Assessment
On June 30, the Governor of New Jersey signed into law a pair of identical bills to increase the current annual assessment rate for net written premiums of HMOs to support charity care.
ICD-10-CM Coding Changes Released for FY 2020
CMS has provided ICD-10-CM coding updates for the fiscal year, starting October 1, 2019 and ending September 30, 2020.
New York Out of Network Surprise Hospital Bill Passes State Senate
A new legislation has been introduced, that is intended to protect New York residents from unexpected surprise bills from hospital emergency department visits would give insurers the ability to pay hospitals outside their networks what they consider reasonable for emergency care, rather than what the hospital charged.
Illinois Legislation Targets Medicaid Managed Care Claim Denials
The Illinois Legislature unanimously passed a health care reform package, which requires Medicaid managed care plans to pay claims within 30 days or face a penalty.
Aetna Makes Changes to National Precertification List
Effective September 1, Aetna will require precertification is required for certain new-to-market drugs.
UnitedHealthcare “Always Therapy” Code Reimbursement Error for Community Plan Claims
On May 21, UnitedHealthcare (UHC) discovered a claim edit was incorrectly loaded into its system. UHC is working to correct the error involving UHC Community Plan claims that included “Always Therapy” codes with and without the GN, GO or GP modifiers were denied for claims submitted on or after May 19, 2019.
Aetna Issues ASC and Ambulatory Payment Classification (APC) Code Edit Updates
Aetna has released updates regarding how the insurer will handle certain ambulatory surgical center (ASC) and ambulatory payment classification (APC) code edits under the ASC and APC payment methodologies.
Anthem Announces Fee Schedule Changes
Anthem Blue Cross and Blue Shield (Anthem) recently notified members of the upcoming changes to its Anthem Plan Fee Schedules, scheduled to take place July 1.
MACPAC Recommends Medicaid Policy Changes For Drug, Hospital Payments
The Medicaid and CHIP Payment and Access Commission (MACPAC) has released its 2019 Report to Congress on Medicaid and CHIP which includes recommendations Medicaid policy changes for outpatient prescription drug and hospital payments, and program integrity.
House Renews Several Medicaid Programs, Including Payment Pilot for Mental Health Clinics
The House passed legislation to renew several Medicaid programs, including an eight state pilot that pays higher reimbursement rates to mental health clinics that offer comprehensive mental health services regardless of ability to pay, offering assistance to patients move out of assisted living facilities, covering costs for individuals whose spouses are in long-term care, and preventing Medicaid fraud.
White House Issues Executive Order on Healthcare Price Transparency
On June 24, the president signed an executive order on price transparency in health care that is intended to lower patient health care costs by providing prices for treatment prior to services being rendered.
CMS Looks at Revising HCAHPS Survey
In a notice to the Office of Management and Budget, CMS requested approval to collect public feedback on possible changes to the Hospital Consumer Assessment of Healthcare Providers and Systems survey (HCAHPS).
