Tagged with ACA Affordable Care Act
Will Your Medical Billing Payer Mix Change in 2022?
Have you noticed changes in your medical billing payer mix? We explain what impacted payer mix in 2021 and what is likely to change in 2022.
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.
Supreme Court Rules Against HHS in DSH Payment Case
In a 7-1 decision, the Supreme Court ruled in favor of the nine hospitals that said the Department of Health and Human Services (HHS) violated the Medicare Act when it changed Medicare’s reimbursement adjustment formula for disproportionate share hospitals without providing notice and opportunity to comment.
CMS Seeks Notice of Ownership Changes at Accreditation Organizations
CMS proposed a rule that would give the agency earlier notice of a potential sale or merger of an accrediting organization such as the Joint Commission.
CMS Releases FY 2020 IPPS Proposed Rule
The proposal updates Medicare payment policies for hospitals under the Inpatient Prospective Payment System (IPPS) for fiscal year (FY) 2020.
New Hampshire Senate Passes Medicaid Telehealth Bill
The New Hampshire Senate has passed a bill expanding Medicaid coverage for telehealth services. The bill, if finalized, would allow a patient to receive primary care in addition to specialty care via telehealth and enables Medicaid to cover far more connected care services than previously.
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.
Illinois Legislature Overrides Veto of Short-Term Health Plan Limit
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).
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.
Virginia – House Passes Medicaid Expansion
The Virginia House of Delegates recently passed a state budget that includes funding for Medicaid expansion and stricter work requirements. If finalized, the state budget legislation would expand Medicaid eligibility to about 400,000 low-income adults.
New Jersey – State Passes Legislatures to Stabilize Market, Prevent Surprise Bills
The New Jersey Legislature recently approved two bills targeting state healthcare stabilization, as well as measures to protect patients from surprise out-of-network costs.
Maryland – State Approves Bills Intended to Stabilize Insurance Market
The Governor of Maryland has passed legislation which seeks to stabilize Maryland’s health care insurance market and prevent rates from increasing.
Humana Claim Processing Edits
Humana has released several claims processing edits, including updates to Outpatient Prospective Payment System (OPPS), Modifiers 96 and 97, HCPCS Drugs & Biologicals, and other policies.
Final 2019 Notice of Benefit and Payment Parameters Released
CMS and the Department of Health and Human Services (HHS), on April 9, issued the Notice of Benefits and Payment Parameters (NBPP) final rule for plan year 2019, updating policies and standards applying to qualified health plans (QHPs) offered on Affordable Care Act (ACA) Exchanges.
New Hampshire House and Senate Approve Medicaid Expansion Bill
The New Hampshire House Health and Human Services Committee and Senate have passed legislation to reauthorize the state’s Medicaid expansion program for an additional five years, as well as add work requirements, and will also transition beneficiaries from the individual insurance exchange into a managed care model.
Maryland Report Shows All-Payer Model Reduces Admissions, Lowers Costs
According to a new state report, the state of Maryland has seen reductions in hospital admissions and increased cost savings in the first three years since moving forward with its All-Payer Hospital Model.
Department of Health and Human Services Announces Future Changes to Provider Reimbursements
The Department of Health and Human Services (HHS) has announced its plans to overhaul the way the federal government reimburses providers. The Department states, in an effort to improve technology and transparency, it will make changes to interoperability, price transparency, and care delivery through Medicare and Medicaid, and remove regulations that hinder private innovation.
States Consider Individual Mandates in Place of Federal Individual Mandate
Nine states and the District of Columbia have announced they are considering laws that would require residents to purchase health insurance. Connecticut, Rhode Island, New Jersey, and Vermont, are amongst the states considering the state mandates to replace the recently repealed federal individual mandate.
Senate Budget Deal Includes Program Funding, 10 Year CHIP Extension
The Senate has reached its two-year budget deal which includes a 10 year extension to CHIP, funding to combat the opioid epidemic, and repeal of the Medicare Independent Payment Advisory Board.