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HEALTHCARE HEADLINES

TOP STORIES

 * Medicare Managed Care Appeals & Grievances
   
   
   
   Medicare health plans, which include Medicare Advantage (MA) plans – such as
   Health Maintenance Organizations, Preferred Provider Organizations, Medical
   Savings Account plans and Private Fee-For-Service plans – Cost Plans and
   Health Care Prepayment Plans, must meet the requirements for grievance and
   appeals processing under Subpart M of the Medicare Advantage regulations. 
   For a detailed discussion of the Medicare managed care grievance and appeals
   processes, click here.
   
   
   Plans and providers have certain responsibilities related to notifying
   beneficiaries of Medicare appeal rights. If a Medicare health plan denies
   service or payment, in whole or in part, the plan is required to provide the
   enrollee with a written notice of its determination.  Additionally, Medicare
   health plan enrollees receiving covered services from an inpatient hospital,
   skilled nursing facility, home health agency, or comprehensive outpatient
   rehabilitation facility have the right to a fast, or expedited, review if
   they think their Medicare-covered services are ending too soon.
   
   
   
    
   
   

 * New Medicare cards offer greater protection to more than 57 million Americans
   
   
   
   
   New cards will no longer contain Social Security numbers, to combat fraud and
   illegal use
   
   The Centers for Medicare & Medicaid Services (CMS) is readying a fraud
   prevention initiative that removes Social Security numbers from Medicare
   cards to help combat identity theft, and safeguard taxpayer dollars. The new
   cards will use a unique, randomly-assigned number called a Medicare
   Beneficiary Identifier (MBI), to replace the Social Security-based Health
   Insurance Claim Number (HICN) currently used on the Medicare card. CMS will
   begin mailing new cards in April 2018 and will meet the congressional
   deadline for replacing all Medicare cards by April 2019. Today, CMS kicks-off
   a multi-faceted outreach campaign to help providers get ready for the new
   MBI.
   
   

 * Two-Midnight Rule: Initial Reviews to Resume
   
   
   
   Having taken time out for retraining and internal audits, contractors may
   resume initial-phase reviews of Medicare reimbursement claims for short-stay
   inpatient hospital care, CMS says.
   
   

 * Q&A: Submitting claims for observation services
   
   
   
   Q: Did something change with the observation services Composite APC in 2016?
   The director of patient financial services says we no longer receive payment
   for it.
   
   

 * Don't underestimate the importance of good documentation
   
   
   
   It’s an unfortunate part of healthcare today—the lawsuit. Are you ready if
   one is filed against your organization?
   
   

 * Q&A: Should we hardcode modifier -CT?
   
   
   
   Q: Our radiology department is requesting that we add a new modifier to their
   charge description master (CDM), modifier –CT (computed tomography [CT]
   services furnished using equipment that does not meet each of the attributes
   of the National Electrical Manufacturers Association [NEMA] XR-29-2013
   standard). They want this added to the CT scan line items, but they are not
   sure if it is for all of the items or only certain ones. Can you provide more
   information that might help us know how to proceed?
   
   


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