Tagged with Medicare Advantage
Florida First State to Receive Federal Approval for 1135 Medicaid Waiver to Address COVID-19
CMS has announced its approval of Florida’s Section 1135 Medicaid waiver request, giving the state greater flexibility to respond to COVID-19. These increased flexibilities include the removal of service barriers; streamlining provider enrollment processes; allowing care to be provided in alternative settings; suspending certain nursing home screening requirements; and extending deadlines for appeals.
Anthem – Information for Care Providers about COVID-19
Anthem Blue Cross and Anthem Blue Shield (Anthem) has developed a list of frequently asked questions regarding administrative processes and recent changes related to COVID-19.
Aetna Issues Letter to Providers: COVID-19 – Taking Action
Aetna has issued a letter to providers detailing the steps the insurer is taking to ensure beneficiaries have access to testing and treatment for COVID-19.
HHS Releases Final Interoperability Rules
CMS and the Department of Health & Human Services (HHS)’ Office of the National Coordinator for Health Information Technology have released two interoperability rules. The new rules aim to make it easier for patients to access and share their information and aim to end information blocking by requiring public and private entities to securely share health information with patients and penalize those who fail to do so.
UnitedHealthcare Implements Enhancements to Procedure to Modifier Policy
UnitedHealthcare has announced plans to implement certain changes to enhance the Procedure to Modifier Policy for Medicare Advantage plans to include modifiers CT, FX and FY.
CMS Releases 2021 MA and Part D Advance Notice Part II
On February 5, CMS released Part II of the Calendar Year (CY) 2021 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies. In the CY 2021 Advance Notice, the agency is proposing updates and changes to the methodologies used to pay MA plans, Programs of All-Inclusive Care for the Elderly (PACE) organizations, and Part D sponsors.
CMS Releases 2021 Medicare Advantage Risk Adjustment Payment Changes
On January 6, CMS released Part I of its annual Advance Notice of Methodological Changes for calendar year (CY) 2021. The proposed updates include changes to the Part C CMS Hierarchical Condition Categories (HCC) risk adjustment model as well as proposed changes to how risk scores are calculated for Medicare Advantage (MA) payment.
Humana Releases Latest Claims Payment Policy Updates
Humana has published its latest medical claims payment policy updates, including its reimbursement policy for ambulance transportation, requirements for billing and documentation of observation services, as well as a new policy for obstetric billing, including antepartum, delivery and postpartum care.
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.
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.
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.
MedPAC Votes to Setup MA Withholds to Improve Encounter Data
MedPAC commissioners have voted in favor of a recommendation that would instruct CMS to use a payment withhold to incentivize Medicare Advantage (MA) plans to submit accurate, complete encounter data and to run MA provider claims through a contractor to ensure encounter data is handled correctly if enough plans don’t submit the data.
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.
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.
New Jersey, Pennsylvania, Rhode Island – UHC Genetic and Molecular Lab Testing Notification Requirement
UnitedHealthcare will soon require providers in New Jersey, Rhode Island, and Pennsylvania to complete the notification/prior authorization process for genetic and molecular testing performed in an outpatient setting.
CMS Releases 2020 Medicare Advantage and Part D Rates
On April 1, CMS released its finalized payment and policy changes for Medicare Advantage (MA) and Medicare Part D plans for the 2020 coverage year. CMS states the final updates will continue to maximize competition among Medicare Advantage and Part D plans, as well as include important actions to address the nation’s opioid crisis.
Humana Claim Payment Policy Update
Humana has published a new claim payment policy update for durable medical equipment (DME) repair and replacement.