Tagged with Medicaid Billing
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.
Florida – Receives CMS Approval for Behavioral Health Housing Pilot
CMS has approved a Florida section 1115 pilot program that provides behavioral health services and temporary housing to Medicaid beneficiaries with severe mental illness and/or substance use disorders.
Cigna Precertification Updates
Cigna has issued several updates to its precertification list for April 2019.
Humana Updates Preauthorization and Notification Lists for 2019
Humana has posted the recent updates to its preauthorization and notification.
New York – Medicaid Managed Care Expansion Approved for More Counties
WellCare Health Plans announced that it will offer Medicaid managed care, Child Health Plus, and Essential Plan coverage in three more New York counties, after receiving approval from state regulators.
UnitedHealthcare Changes in Advance Notification and Prior Authorization Requirements
UHC has posted a correction to authorization previously published code additions, as well as new codes requiring prior authorization.
New Jersey Will Transition to a State-Based Exchange
On March 22, the governor of New Jersey has announced that the state will transition from the federally operated Healthcare.gov exchange platform to a state-based exchange by the 2021 plan year. According to state officials, the change will give the state more control over its health insurance market.
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.
Humana Claim Payment Policy Update
Humana has published a new claim payment policy update for durable medical equipment (DME) repair and replacement.
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.
CMS Finalizes Medicare OPPS, ASC Rates and Policies for 2019
CMS has finalized Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) rates and policies for calendar year 2019.
CMS Announces Short-Term IMD Exclusion Waivers for Mental Illness
CMS announced on November 13, a new opportunity for states to seek short-term IMD exclusion waivers, which would allow Medicaid to pay for inpatient mental health services for adults with serious mental illness and children with serious emotional disturbance.
Maine – Governor-Elect to Implement Medicaid Expansion
Maine Governor-elect has made statements of intention to implement the state’s voter-approved Medicaid expansion plan immediately upon taking office in January. An estimated 70,000 low-income people would become eligible for Medicaid under the expansion.
CMS Releases CY 2019 Physician Fee Schedule Final Rule
On November 1, CMS released its Medicare Physician Fee Schedule final rule for calendar year (CY) 2019. The latest update includes changes to the Quality Payment Program as well as documentation and payment adjustments for evaluation and management services.
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.
CMS Updates Policies and Payment Rates for ESRD/DME NPRM, DMEPOS
CMS has issued a final rule that updates payment policies and rates for Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) and the End-Stage Renal Disease (ESRD) programs.
