Anticipated Medicare fee schedule to release administrative burden – Let the Doctors remain Doctors
There are proposed policy revisions in Medicare payment schedule by American Medical Association (AMA) in collaboration with Centers for Medicare and Medicaid Services (CMS). The aim is to streamline reporting requirements, reduce paperwork, improve workflow and contribute to a better environment for healthcare professionals as well as their Medicare patients.
The provision to alter how documenting & coding (E/M Services) stands out and will be implemented in 2021, worked on by both AMA & CMS with the help of the medical community. This showcases the complexity of the rendered services and the resources required. This is a big step in curbing the documentation burdens in medicine.
This proposal reveals the raised complexity of these services and the means needed to provide them, the significance of this represents an initiative towards reducing administrative burdens in medicine and make it easy for doctors to concentrate on providing quality services to patients. The AMA is fully prepared to help the entire healthcare community system through implementing the simplified method to E/M coding and documentation with an aim to encourage key principles of accessibility, quality, affordability and innovation.
CMS show its pledge in lining up patients over paperwork, collaboration with the medical community is a rigorous effort to further improve former policies and proposals. CMS and AMA is looking forward for further collaboration together with joint aim of providing high-value care to the patients.
Consumer Protection Law Enacted to Safeguard against Surprise Billing - Senate Bill 1264
As of the signing of Senate Bill 1264 on June 14th, Texas is now among a slew of states that have consumer protection laws in place for Surprise billing.
The bill will be effective as of September 2019 and will focus on getting rid of surprise billing for some specific health plans as well as the mandatory mediation requests and also by implementing limitations on surprise billing information being reported by reporting agencies.
Under the new bill, mediation will not require involvement from the patient at all but instead it will be between the health plan and the provider and it will be managed by an impartial mediator. All types of providers can request help with mediation from the state and the cost of that mediator will be then split between the respective parties. It is then the responsibility of the state to notify the affected parties that are so named in the mediation request.
As per the legislation, mediation must be started within 180 days of the request being submitted. The new bill also requests health plans to pay any emergency care given by any out of network providers at an established rate that the organization considers reasonable.
From 26th August 2019 onwards, Blue Cross and Blue Shield of Texas is updating its in-house review process for behavioral health claims that need benefit preauthorization. This should be taken into consideration that updates are for the claim review process only. There is no change in Benefit preauthorization required by particular services and the process for submitting benefit preauthorization requests.
How does these changes have an impact? It must be ensured that claims are billed properly. Remember, for all claims:
CMS Audit Cycle - 2019
CMS originate a new audit phase in 2019 and believe the length will be consistent with preceding phases. While sponsoring organizations are usually audited once per audit cycle, CMS can audit a sponsoring organization more than once throughout the cycle based on risk or audit referral.
Indianapolis-based health insurance giant Anthem Inc. announced Thursday that it has agreed to buy Beacon Health Options—the largest independent behavioral health organization in the country—for an undisclosed price.
Anthem plans to buy Boston-Based Beacon Health Options, the country's largest independently held behavioral health provider. Beacon cares for about 36 million people across all 50 states with 3 million enrolled in a comprehensive risk based model. According to anthem, acquiring Beacon aligns with Anthem's broader strategic goal of expanding further into the provider space and integrating services more fully.
Acquisition will allow it to offer integrated behavioral and physical healthcare services to customers Nationwide. Beacon will be combined with Anthem's existing behavioral health business.
The Texas Health and Human Services Commission (HHSC) is preparing to roll out its new provider and enrollment system. With the help of associating and switching some processes and systems, the new Provider Management and Enrollment System (PMES) will reduce administrative burden for providers.
The following processes and systems will be consolidated into the PMES system:
PMES Rollout Timetable and Feedback Opportunity:
Throughout 2019, the HHSC will be preparing for a March 2020 implementation of the new system:
Benefits of New PMES System for Providers
One of the real joys this holiday season is the opportunity to say THANK YOU to all of our customers for their loyalty to Claims Med. We wish you the very best holiday and a Happy New Year filled with health, happiness, and spectacular success!
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Season Greetings and Happy Holidays!
Thanksgiving Holiday Hours
Dear Valued Customers,
Please note Claims Med will be closed during the following days as we spend time with our family and friends in observance of the Thanksgiving Day Holiday.
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