Tagged with Multi-Specialty-Billing

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 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.

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.

Anthem Medical Non-Oncology Specialty Drug Review Changes

Anthem Blue Cross Blue Shield (Anthem) continues to streamline its medical specialty drug reviews by transitioning another drug review process from AIM to Anthem’s medical specialty drug review team. Beginning June 15, for all requests, regardless of service date, providers will need to submit a new prior authorization request by contacting Anthem’s medical specialty drug review team.

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.

House Renews Several Medicaid Programs, Including Payment Pilot for Mental Health Clinics

The House passed legislation to renew several Medicaid programs, including an eight state pilot that pays higher reimbursement rates to mental health clinics that offer comprehensive mental health services regardless of ability to pay, offering assistance to patients move out of assisted living facilities, covering costs for individuals whose spouses are in long-term care, and preventing Medicaid fraud.

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