Tagged with Hospitalist Billing
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.
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).
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.
Atena Updates Payment Process for Certain ASC and APC Code Edits
Aetna has posted updated information 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.
New York City to Implement Health Care Program for the Uninsured
The mayor of New York City has given his approval to move forward with implementation the state’s NYC Care program, an initiative to provide health care to individuals without insurance. NYC Care will be launched in the Bronx on August 1, and will be fully implemented across the city by the end of 2020.
New Jersey DHS Provides Update on MLTSS, Nursing Facility ‘Any Willing Qualified Provider’ Reimbursement Model
New Jersey’s reimbursement parameters for its MLTSS program are intended to be transitioned to a new, quality-based Any Willing Qualified Provider (AWQP) reimbursement model. DHS says it intends to award AWQP designation status to NFs this spring and review it annually.
CMS Announces New Medicare Primary Care Payment Model
CMS, along with the HHS, has announced plans to launch five new Medicare primary pare payment models.
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.
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.
Humana Launches Oncology Model to Reward Integrated Care
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.
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.
CMS Medicare Billing Reminder for Cardiac Device Credits
CMS has released a reminder regarding correct billing for recalled cardiac medical in compliance with Medicare requirements for reporting manufacturer credits.
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.
Anthem BCBS Professional Bundled Services and Supplies Update
Anthem has released an update regarding the coding of bundled services for continuous intraoperative neurophysiology monitoring, from outside the operating room.
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.
New York – Anthem Reimbursement Policy Updates
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.
CMS Publishes Final CY 2019 Medicare Physician Fee Schedule Rates and Policies
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.
