Tag: CMS (Medicare and Medicaid)
Optum Temporary Funding Assistance
The Temporary Funding Assistance Program is designed to help bridge the gap in short-term cash flow needs for providers impacted by the disruption of Change Healthcare’s services.
Eligible providers:
- Providers who receive payments from payers that are processed by Change Healthcare.
- UnitedHealthcare medical, dental and vision providers.
- Providers who have exhausted all available connection options or may be in the process of implementing technical workaround solutions and who work with a payer who has opted not to advance funds to providers during the period when Change Healthcare systems remain down
For questions contact (877) 702-3253
Your Mac is Novitas Solutions
Today, HHS is announcing immediate steps that the Centers for Medicare & Medicaid Services (CMS) is taking to assist providers to continue to serve patients. CMS will continue to communicate with the health care community and assist, as appropriate. Providers should continue to work with all their payers for the latest updates on how to receive timely payments.
Medicare providers needing to change clearinghouses that they use for claims processing during these outages should contact their Medicare Administrative Contractor (MAC) to request a new electronic data interchange (EDI) enrollment for the switch. The MAC will provide instructions based on the specific request to expedite the new EDI enrollment. CMS has instructed the MACs to expedite this process and move all provider and facility requests into production and ready to bill claims quickly. CMS is strongly encouraging other payers, including state Medicaid and Children’s Health Insurance Program (CHIP) agencies and Medicaid and CHIP managed care plans, to waive or expedite solutions for this requirement
CMS has contacted all of the MACs to make sure they are prepared to accept paper claims from providers who need to file them. While we recognize that electronic billing is preferable for everyone, the MACs must accept paper submissions if a provider needs to file claims in that method.
Novitas Phone # (855) 252-8782. Have your PTAN and the last 5 of your TIN.
Updated Clinical Prior Authorization
Assistance Chart Now Available
An update to the Clinical Prior Authorization Assistance Chart is available. The chart identifies which clinical prior authorization each MCO uses and whether the MCO uses all or some of the steps in the evaluation process.
New Prior Authorization Ruling Applies to Some,
But Not All.
In December 2022, I reported on a proposed rule from the Centers for Medicare & Medicaid Services (CMS) about updating requirements for prior authorization (PA), a process that many providers and patients consider to be a roadblock to obtaining care. Now, CMS has published the Final Rule (020824) on this topic, which contains significant requirements for health plans to follow to improve the process.
The rule only applies to a set of Impacted Payers: Medicare Advantage (MA) organizations, state Medicaid and Children’s Health Insurance Program (CHIP) Fee-for-Service (FFS) programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan (QHP) issuers on the Federally Facilitated Exchanges (FFEs).
Legally, these are the plans for which CMS can set requirements. However, it is expected that many commercial plans will voluntarily adopt some of these provisions.
The rule also adopts a new measure for Merit-Based Incentive Payment System (MIPS)-eligible clinicians under the Promoting Interoperability performance category of MIPS, as well as for eligible hospitals and critical access hospitals (CAHs), under the Medicare Promoting Interoperability Program.
For more information and detail, follow this link to the article written by Stanley Nachimson, MS
Don’t Miss UHC Updates
Texas Medicaid: Adjustment reimbursement methods coming soon
Texas Medicaid: Prior autorization updates for certain medications
Receive More Accurate Payment for Medicare Complex Visits.
The new code will take effect Jan. 1, 2024. The 2024 Medicare Physician Fee Schedule allows physicians to list G2211 in addition to codes used in-office or outpatient visits for new or established patients (i.e., 99202-99215). Physicians can also use it for telehealth visits.
Texas Medical Association continues to push for additional guidance as confusion over the code’s use persists.
CMS Extends Telehealth Flexibilities to Protect Physician Privacy.
Following staunch advocacy by the Texas Medical Association, the Centers for Medicare & Medicaid Services (CMS) will not require physicians to list their home address as a practice location on Medicare enrollment forms for another year when providing telehealth services, safeguarding their privacy and safety.
During the COVID-19 pandemic, CMS allowed physicians to offer telehealth services from their homes without reporting their home address on their Medicare enrollment. However, that flexibility was set to expire Dec. 31.
MLN Connects News
2024 Medicare Part B Deductible.
The annual deductible for all Medicare Part B beneficiaries will be $240 in 2024, an increase of $14 from the annual deductible of $226 in 2023.
Discarded Drugs and Biologicals:
When to Use JW and JZ Modifiers.
Read updated JW and JZ Modifier FAQs for additional clarity on billing with these modifiers (see FAQs 7, 8, and 18–22). CMS posted a new list of billing and payment codes only used for single-dose containers that may require the modifiers, depending on the setting:
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