Category: Medicare
Cigna MA Plans for 2023
The below list is for Provider use only. Not to be distributed to Patients.
Know your “H” numbers.
HMO Customer Benefit Plans for Our Service Area
PPO Customer Benefit Plans for Our Service Area
Cigna Preferred Medicare HMO, H4513-061
Cigna True Choice Medicare PPO, H7849-038
Cigna Preferred Savings Medicare HMO, H4513-066
Cigna Tru Choice Medicare PPO, H7849-062
Cigna Courage Medicare HMO, H4513-009
Cigna TotalCare HMO D-SNP, H4513-060
Great News for Insulin Dependent Medicare Patients
In August 2022, the Inflation Reduction Act (IRA) was passed. Among other items it will lower prescription Drug Costs for Seniors.
The Inflation Reduction Act (IRA) will help close the gap in access to medication by improving prescription drug coverage and lowering drug prices in Medicare.
The Law:
- Caps the amount that seniors will have to pay for prescription drugs they buy at the pharmacy at $2000 a year.
- Caps the amount that seniors will pay for insulin at $35 for a month’s supply.
- Provides access to a number of additional free vaccines, including the shingles vaccine, for Medicare beneficiaries.
- Will further lower prescription drug costs for seniors by allowing Medicare to negotiate the price of high-cost drugs and requiring drug manufacturers to pay Medicare a rebate when they raise prices faster than inflation.
From CMS.gov/newsroom, People with Medicare drug coverage will pay nothing out-of-pocket for adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), including the shingles and Tetanus-Diphtheria-Whooping Cough vaccines, starting in 2023.
2023 Arcadia 360 Is Up and Running
Medicare Advantage
- The 2023 Arcadia 360 is ready and available for providers. There are no form content changes for 2023 at this time. (Providers have already begun submitting 360s through Arcadia for 2023.)
- One known issue: pre-population from 2022 forms into 2023 forms is not currently working. This will be resolved with a new release coming this week. Exact release details and timing will be communicated once tested and confirmed. This applies to the following fields: past medical history, surgical history, allergies, medications, family history.
- The conditions tab and measures tab will populate with data as expected, if applicable.
UHC Relief At Last!!
Finally, Some United HealthCare Relief!
As of this morning POET has acquired a list from UHC regarding the products for our Agreement.
If you are having issues with any par plans on this list. Please email a copy of the card and patients date of birth to [email protected]. Include a brief description of the issue.
Remember this information is confidential and pertains only to the POET Agreement.
2023 Medicare Physician Fee Schedule Final Rule
On November 01, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates and policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2023.
TX Resources for Family
Physicians who frequently refer patients to no- and low-cost state services like health insurance and child care will find that easier now that the state has launched familyresources.texas.gov, a website that puts links to those services all in one place.
Who ya’ gonna call?
HAVING ISSUES WITH MEDICARE CALLS?
Who do you call? A source from MGMA shared this information.
They suggest you file a complaint and email CMS leadership. Because complaints go to “low-level” administrative staff whose entire goal is to close them.
Create a complaint letter detailing your experience. Email it to CMS Administrator Chiquita Brooks-LaSure Administrator and CC to the relevant CMS leadership as follows:
CMS Administrator: Chiquita Brooks-LaSure [email protected]
Deputy Chief Operating Officer: Karen Jackson [email protected]
Director Office of Program Operations & Local Engagement: Nancy O’Connor [email protected]
Deputy Administrator and Director Center for Medicare: Meena Seshamani, M.D., PhD [email protected]
Deputy Administrator & Director Center for Medicare & Medicaid Innovation: Elizabeth Fowler [email protected]
Deputy Administrator and Director Center for Consumer Information & Insurance Oversight: Dr. Ellen Montz [email protected]
Deputy Director: Cheri Rice [email protected]
Seasonal Influenza Vaccines Pricing
The Medicare Part B payment allowance limits for seasonal influenza (flu) vaccines are 95% of the Average Wholesale Price (AWP), as reflected in the published compendia.
In hospital outpatient departments, payment is based on reasonable cost.
Annual Part B deductible and coinsurance amounts don’t apply for the influenza virus vaccinations. All physicians, non-physician practitioners, and suppliers who administer these vaccinations must take assignment on the claim for the vaccine.
Annual Influenza Vaccine season starts on August 1 and ends on July 31 of the following year.
Payment Allowances and Effective Dates by Flu Season
Humana Physician News
A Wealth of Information Just Waiting for You.
- Humana’s Neighborhood Centers offer patients one on one health education.
- Value-based care reduces acute care.
- Earn CME by attending the CMS Statin Webinar.
- Complete your annual 2022 Compliance Training.
- Many Resources and Support.
Cigna Network News 3rd Qtr 2022
Some Highlights:
- Covid Updates
- Virtual Care Services POS 02
- Policy Updates: Preventive Care, Precertification, Reimbursement and more
- Tips for online reconsiderations and appeals
- Advantage Plan Highlights
- And much more.
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