Jul 27, 2016 | Uncategorized
The Justice Department is suing to block two proposed mergers between major health insurance companies, saying the deals violate antitrust laws and would lead to higher health care costs for Americans.nnU.S. Attorney General Loretta Lynch explained the decision at a press conference:n
“If allowed to proceed, these mergers would fundamentally reshape the health insurance industry. They would leave much of the multitrillion-dollar health insurance industry in the hands of three mammoth insurance companies, drastically constricting competition in a number of key markets that tens of millions of Americans rely on to receive health care.nn”Among other consequences, the number of health insurance options available to nationwide employers would shrink from four to three. Two of the largest and fastest-growing providers of Medicare Advantage plans, which millions of seniors rely on for crucial medical coverage, would combine into just one. And competition would be substantially reduced for hundreds of thousands of families and individuals who buy insurance on the public exchanges established under the Affordable Care Act.”
nThe lawsuits filed Thursday morning challenged a $37 billion merger between Humana and Aetna, which the Justice Department alleges “would lead to higher health-insurance prices, reduced benefits, less innovation, and worse service for over a million Americans,” and a $54 billion acquisition of Cigna by Anthem, which the court filing states would be the largest merger in the history of the health insurance industry.n
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nThis article originally posted on NPR.org.
Jul 27, 2016 | Uncategorized
T67.0XXD — Heatstroke and sunstroke, subsequent encounternnY93.02 — Activity, runningnnY92.414 — local residential or Business Street as the place of occurrence of the external cause
Jul 26, 2016 | Uncategorized
On July 7, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that updates payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2017. This year, CMS is proposing a number of new physician fee schedule policies that will improve Medicare payment for those services provided by primary care physicians for patients with multiple chronic conditions, mental and behavioral health issues, and cognitive impairment or mobility-related disabilities.nnCMS is proposing to expand the Diabetes Prevention Program model starting January 1, 2018. This is the second CMS Innovation Center – and first preventive services – model that has been certified for expansion. Expansion of this model will enhance access to these important services for Medicare beneficiaries who are at risk for developing diabetes.nnIn addition CMS is also:n
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- Proposing modifications to the Medicare Shared Savings Program to update the quality measures set and align with the proposals for the Quality Payment Program, changes to take beneficiary preferences for ACO assignment into consideration, and changes that would improve beneficiary protections when ACOs are approved to use the skilled nursing facility (SNF) 3-day waiver rule;
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- Requiring health care providers and suppliers to be screened and enrolled in Medicare in order to contract with Medicare Advantage health plans to provide Medicare-covered items and services to beneficiaries enrolled in Medicare Advantage;
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- Increasing transparency of Medicare Advantage pricing data and medical loss ratio (MLR) data from Medicare health and drug plans, and;
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- Continuing to implement Appropriate Use Criteria for advanced diagnostic imaging services, including proposals for priority clinical areas and clinical decision support mechanism (CDSM) requirements, among other proposals as detailed in this fact sheet.
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nThe CY 2017 PFS proposed rule is one of several proposed rules that reflect a broader Administration-wide strategy to create a health care system that results in better care, smarter spending, and healthier people.n
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nThis article originally posted on CMS.gov.
Jul 25, 2016 | Uncategorized
S62.035A — Non–displaced fracture of proximal third of navicular [scaphoid] bone of left wrist, initial encounter for closed fracturennY93.18 — Activity, surfing, windsurfing and boogie boardingnnY92.832 — Beach as the place of occurrence of the external causenn
Jun 21, 2016 | Uncategorized
Novitas Solutions Update: Automated Claim Correction via the Interactive Voice Recognition (IVR) Unit – Coming Soon!
nAutomated Claim Correction via the Interactive Voice Recognition (IVR) unit is coming soon, which will allow you to conduct an unlimited number of telephone claim corrections for select Medicare Part B claims via the IVR. In order to ensure the best possible automated claim correction tool to valued customers, Novitas Solutions has revised their implementation schedule as follows:nn
nnLearn More – Webinars Coming Soon!nnWant to know more and be prepared for your implementation? Visit the Novitas Solutions website for webinar dates and more information!
Jun 17, 2016 | Uncategorized
Learn All About Colorado Medicaid’s New Name
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nCheck out this release from Colorado Medicaid on their re-branding. You won’t want to miss out on this interesting opportunity to learn more about upcoming changes to the Colorado Medicaid program. nnnColorado Medicaid is changing its name to Health First Colorado (Colorado’s Medicaid Program) this summer. Join the Colorado Department of Health Care Policy & Financing for a webinar exclusively for health care providers to learn about this exciting change! Two dates are available for the webinar. Pick the date below that works best for you and your team.nnWednesday, June 22, 2016n12:00 – 1:00 pm MTnClick here to register-June 22nnTuesday, June 28, 2016n12:00 – 1:00 pm MTnClick here to register-June 28 Who Should Attend?nnHealth care providers and office staff who interact with Medicaid patients or the Department of Health Care Policy & Financing should attend this webinar to learn about the name change and what is affected by the change.nnWhy Attend?nnLearn about why Colorado Medicaid is changing its name, and how this affects your patients and practice. We will also direct you to helpful resources to educate your patients about the change.nn*Presentation Materials will be available for download following the webinar.
