Tagged with Medicare Billing
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 Notice on Bypassing Payment Window Edits for Donor Post-Kidney Transplant Complication Services
CMS has posted a notice for physicians, hospitals, and other providers billing Medicare Administrative Contractors (MACs) to ensure the payment window edits are bypassed when processing claims for donor post-kidney transplant complications services.
CAR T-Cell Cancer Therapy Available to Medicare Beneficiaries Nationwide
On August 7, CMS finalized the decision to cover Food and Drug Administration (FDA)-approved Chimeric Antigen Receptor T-cell (CAR T-cell) therapy, which is a form of cancer treatment that uses a patient’s own genetically-modified immune cells to fight disease. FDA-approved CAR T-cell therapies are approved to treat some people with specific types of cancer – certain types of non-Hodgkin lymphoma and B-cell precursor acute lymphoblastic leukemia.
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.
Aetna Issues ASC and Ambulatory Payment Classification (APC) Code Edit Updates
Aetna has released updates 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.
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 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.
CMS Finalizes Rule to Update and Modernize PACE
CMS has announced the release of a final rule designed to “update and modernize” the Programs of All-Inclusive Care for the Elderly (PACE) program, based upon best practices in caring for frail and elderly individuals.
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.
CMS Finalizes Rule to Streamline Medicare Appeals Process
CMS has issued a final rule clarifies changes it has made to the appeals process in the Medicare program for providers, beneficiaries, and suppliers, and streamlines the process for Medicare Parts A and B claims appeals and for Medicare Part D coverage determination appeals.
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.
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.
New Legislation Aims to Strengthen Stark Law
The Promoting Integrity in Medicare Act (PIMA) seeks to update Medicare policies by preventing self-referrals related to advanced imaging services, radiation therapy, anatomic pathology and physical therapy.
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.
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.
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.
