CMS recently published the proposed Medicare Physician Fee Schedule for 2020. In addition to updating the Medicare conversion factor to $36.0896, a slight increase above the 2019 PFS conversion factor of $36.0391, the proposed rule also includes changes to several payment policies. We’ve highlighted a few of the biggest changes. READ MORE
An Anthem policy which allows documentation reviews of OB anesthesia cases longer than 300 minutes caused some confusion with the phrase “based on the time the provider is physically present with the member” because it could be interpreted as a departure for how OB anesthesia is normally billed. Anthem has offered a clarification. READ MORE
Eligible providers who participated in MIPS in 2018 can now review their performance reports, and 2017 MIPS participants can expect to see some performance information on the Physician Compare website. READ MORE
As the surprise billing debate continues, emergency physicians have begun lining up behind one bipartisan House bill. READ MORE
Just weeks after Anthem announced then retracted a new post-payment review policy for emergency department level 5 services for its commercial plans in some states, the payer has now announced that the policy will be implemented for Medicare Advantage plans in most states where Anthem conducts business. READ MORE
Beginning in June 2019, the Centers for Medicare and Medicaid Services will begin performing data validations and audits on the 2017 and 2018 performance years of the Merit-based Incentive Payment System. READ MORE
After more than a year of working on a new provider enrollment and credentialing solution – FSSA EnCred – the Indiana Family and Social Services Administration’s has now suspended the project indefinitely. READ MORE
Two issues at the center of the U.S.’s ongoing health debate have drawn the attention of the American Society of Anesthesiologists (ASA): surprise billing and Medicare for All. In both cases, the ASA sees big problems with proposals that tie new policies with existing Medicare payment rates, which for anesthesiologists typically run about a third of what commercial payers pay. READ MORE
In this roundup on surprise billing, we offer a big picture view of the issue, with who’s proposing what and who’s not happy about it. Plus, look for lots of links to follow to read up on the details. READ MORE
Anthem Blue Cross and Blue Shield recently announced a new policy of post payment reviews of professional ER claims billed with level 5 E/M codes. The new policy is being implemented to “ensure documentation meets or exceeds the components necessary to support its billing,” according to Anthem, and will begin August 1. Indiana and a few other states currently are excluded. READ MORE
