Insurers can offer premium discounts or other incentives to engage in healthy activities, but questions remain as to whether wellness programs work. Affordable Care Act plans in 10 states will be able to offer wellness programs, as employer-sponsored plans have been doing for years. The Centers for Medicare and Medicaid Services on Monday announced the opportunity for […]
The Senate passed a continuing resolution that would temporarily stop the implementation of Medicaid DSH payment cuts until Nov. 22, 2019. CMS on Monday finalized a rule that will reduce Medicaid Disproportionate Share Hospital (DSH) payments by $4 billion next year and $8 billion a year until fiscal year 2025. The new final rule will implement Medicaid DSH payment […]
CMS wants to identify bad actors -– even if they are or have been affiliated with a legitimate provider. On Sept. 5, the Centers for Medicare & Medicaid Services (CMS) issued a new final rule. There was not really a proposed rule to which comments and suggestions could be made; there were Federal Register entries […]
Hospitals assuming downside financial risk under value-based care models is the key to lowering healthcare costs and improving quality, CMS believes. CMS Administrator Seema Verma urged hospitals on Tuesday to accept new value-based care models and price transparency requirements or face greater administrative burden, less competition, and lower reimbursement rates under Medicare for All. “Our choices are […]
Now that revolutionary cancer therapy, Chimeric Antigen Receptor T-cell (CAR T-cell), is covered, let’s take a look coding CAR T. Last month the Centers for Medicare & Medicaid Services (CMS) finalized the long-sought rules for coverage of CAR-T, novel cutting-edge, often curative treatments that utilize the patients’ own genetically modified immune cells to fight cancer. The […]
CMS’ proposed 2020 Medicare Physician Fee Schedule includes substantial changes to the rules for obtaining and maintaining Medicare billing privileges. A one-paragraph statement in the proposed rule calls for applying Medicare enrollment approval and revocation rules for opioid treatment programs to all physicians and other eligible professionals. The proposal would allow CMS to revoke Medicare […]
Physicians work hard to generate revenue, and with slim operating margins, they don’t want to contend with costly recoupments. Compliant coding and billing helps them avoid the focus of a pre- or post-payment audit. This article discusses four services that physicians say pose payment challenges along with general tips for coding compliance. Annual wellness visits […]
The new Plan Finder walks users through the Medicare Advantage plan and Part D enrollment process from start to finish. For the first time in a decade, the Centers for Medicare and Medicaid Services has launched a modernized and redesigned Medicare Plan Finder. The Medicare Plan Finder, the most used tool on Medicare.gov, allows users to […]
CMS has provided ICD-10-PCS updates for fiscal year 2020 that include 2,056 deletions. Here are 20 of the deleted codes: 0370046 – Dilation of right internal mammary artery, bifurcation, with drug-eluting intraluminal device, open approach 0372046 – Dilation of innominate artery, bifurcation, with drug-eluting intraluminal device, open approach 0374056 – Dilation of left subclavian artery, bifurcation, with […]
Providers are encouraged to file protective appeals. “In section XI of the preamble of the proposed rule, we discussed the growing number of Provider Reimbursement Review Board (PRRB) appeals made by providers and the action initiatives that are being implemented with the goal to decrease the number of appeals submitted; decrease the number of appeals […]