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Medirite News

CMS Seeking Provider Help to Align Quality Reporting

CMS is seeking help from providers to give them information on how clinical quality measure data that physicians are already reporting to medical boards, specialty societies, and other nonfederal programs, can be used to meet requirements of CMS  incentive programs |

NJ - AmeriHealth - Migrating to Highmark Gateway

Beginning this year, AmeriHealth Administrators will be migrating X12 transactions from the NaviNet Gateway to the Highmark Gateway. The intent is to streamline and improve processing activities. AmeriHealth expects to gain efficiencies lower operating costs as well as add new capabilities that enhance the overall customer experience | 

NY - EMPIRE BCBS Updates Reimbursement Policies

Anthem BCBS updated their Provider Services (AOPS) website with the following new and/or revised reimbursement policies.   Frequency Editing – Professional   For claims processed on or after February 18, 2013, Empire BCBS’ frequency Editing policy has been revised to add a frequency limit of four (4) units |

UnitedHealthcare - Medicare Solutions Reimbursement Policies

UnitedHealthcare publishes their policies that are related to CMS’ National Coverage Determinations (NCDs) and those related to Local Coverage Determinations (LCDs) and UnitedHealthcare Coverage Summaries.  The content within the Medicare Solutions Reimbursement Policies includes: A summary of each policy, which may include coverage indications and/or limitations. Relevant CPT/HCPCS and ICP/PCS coding Particular |

Medicaid Primary Care Rate Increase

For calendar years 2013 and 2014, Section 1202 of the federal Affordable Care Act (ACA) requires Medicaid agencies to reimburse Medicare payment rates for the following primary care services provided by the listed primary care physicians.   Eligible Services E & M Codes 99201-99499 CPT vaccine administration codes 90460, 90461, 90471  |

Medicare EHR Incentive Program Participation

Eligible professionals (EPs) who participated in the Medicare EHR Incentive Program in 2012 must complete attestation by February 28, 2012 in order to receive an incentive payment.  EPs must also have completed their reporting requirements by December 31, 2012. CMS encourages Medicare EPs to register and attest as soon as possible |

Aetna Medicare Advantage Cost Share Changes in 2013

Effective January 1, 2013, Aetna Medicare Advantage (MA) HMO plan members’ cost sharing responsibilities for certain benefits will change. Instead of a copayment, Aetna MA HMO plan members will be required to pay coinsurance for the following benefits:

  • Part B Drugs
  • Durable Medical Equipment (DME)
  • Complex Radiology (MRI, MRA, PET)

The amount they pay will be the applicable coinsurance percentage multiplied by Aetna’s reimbursement rate. This means the physician’s office must determine the applicable coinsurance amount the MA HMO plan members will owe when they receive these benefits |

Medicare Premiums & Deductibles for 2013

CMS has released the Medicare premiums and deductibles for Medicare beneficiaries in 2013. Medicare Part B – Physician & Non-Physician Services Coverage CMS will increase the Medicare Part B premium $5 a month to $104.90 a month |

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