Tagged with Multi-Specialty-Billing
CMS Final Rule Blocks States from “Diverting” Provider Medicaid Payments to Third Parties
CMS, in early May, released the Medicaid Provider Reassignment Regulation final rule removing a state’s ability to divert portions of Medicaid provider payments to third parties outside of the scope of what the statute allows. Under the rule, CMS is revoking the authority of states to “divert” certain Medicaid provider payments to a third party to fund other costs on behalf of the provider “for benefits such as health insurance, skills training, and other benefits customary for employees.”
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.
UHC Participating Provider Laboratory and Pathology Protocol Update
Effective June 1, more network care providers will be required to obtain consent from UnitedHealthcare or UnitedHealthcare Oxford members before referring them to or using out-of-network laboratories and pathologists for their care.
FDA Shares Two Guidance Documents for Imaging Providers
The FDA has published two new guidance documents designed to align the agency’s requirements for x-ray imaging devices with various international standards.
CMS Claim Status Category and Claim Status Codes Update
CMS has released updates to the claim status and claim status category codes used for the Accredited Standards Committee, Health Care Claim Status Request and Response and ASC Health Care Claim Acknowledgment transactions.
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.
Humana New, Revised Medical Coverage Policies Implemented
Humana has released its most recent medical coverage policy changes, including updates to its Code Compendium (Ophthalmology) and Laser Interstitial Thermal Therapy policies.
United Healthcare Announces Coordinated Commercial Reimbursement Policy Changes
UnitedHealthcare has released changes to its coordinated commercial reimbursement policy, which includes updates to its procedure to modifier policy and consultation services policy.
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.
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.
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.
UHC Network National Laboratory Services Care Providers for 2019
In 2019, UnitedHealthcare (UHC) will be growing its national network of participating laboratory providers to better support members and the care providers who order laboratory services.
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.
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.
Wisconsin – Anthem Medical Policies and Clinical UM Guidelines Update
Anthem Wisconsin has updated certain medical policies and clinical utilization management (UM) guidelines to support clinical coding edits.
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.