Tagged with Emergency Medicine Billing
Executive Order Issued to Protect Traditional Medicare and MA Plans
The president, on October 3, signed an executive order directing the Department of Health and Human Services to increase efforts to provide more insurance plan options under Medicare Advantage and to remove regulations that are considered burdensome to health care providers. The order is intended to protect traditional Medicare and private Medicare Advantage while ramping up alternative payment models, time spent with patients, access to innovative technology and reducing the regulatory burdens on providers.
Aetna Wisconsin Issues New Preapproval Requirements for Members
Effective July 1, Aetna will require prior authorization for certain procedures under its Enhanced Clinical Review Program with eviCore healthcare.
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 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.
Pennsylvania Lawmakers Propose Bill Package to Combat Opioid Crisis
The Pennsylvania Senate has approved a package of bills to collectively combat the state’s heroin and opioid epidemic. The legislation includes seven bills, each designed to address specific issues and areas pertaining to opioid prescription and abuse.
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.
Senate Health Committee Draft Legislation Targets Health Care Costs
Senate Health Committee leaders have proposed a legislative health care package which aims to reduce health care costs for individuals by addressing surprise medical bills, drug price transparency, and pharmacy benefit management.
UHC Participating Provider Laboratory and Pathology Protocol Update
Effective June 1, more network care providers will be required to obtain consent from UnitedHealthcare or UnitedHealthcare Oxford members before referring them to or using out-of-network laboratories and pathologists for their care.
FDA Shares Two Guidance Documents for Imaging Providers
The FDA has published two new guidance documents designed to align the agency’s requirements for x-ray imaging devices with various international standards.
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.
Fourteen States Address Imaging-Focused Legislation
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.
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.
Aetna Update for CPT II Codes for High Blood Pressure Measurements
Aetna has issued an update regarding the use of CPT II codes for HEDIS® high blood pressure measurements for patients diagnosed with hypertension.
Humana Claim Payment Policy Update
Humana has published a new claim payment policy update for durable medical equipment (DME) repair and replacement.
Connecticut – Provider Termination Requirements
Aetna has posted a reminder regarding provider contract termination requirements in the state of Connecticut.
