This proposed rule would lay out a structure and options for coordinating Medicaid, CHIP, and Exchange eligibility notices and appeals; provide additional benefits and cost-sharing flexibility for state Medicaid programs; and codify several provisions included in the Affordable Care Act and Children’s Health Insurance Program Reauthorization Act (CHIPRA). Key Provisions Process for Appeals of Eligibility […]
Procedures That Will be Paid Only as Inpatient for CY2013 This is a zip file for download. CPT® license agreement required. CY2013 OPPS Addenda [ZIP, 2.1 MB] (The 2013 Inpatient Only List is here as Addendum E.)
This final rule implements Medicaid payment for primary care services furnished by certain physicians in calendar years (CYs) 2013 and 2014 at rates not less than the Medicare rates in effect in those CYs or, if greater, the payment rates that would be applicable in those CYs using the CY 2009 Medicare physician fee schedule […]
CMS issued a final rule with comment period for Medicare’s payments for physician fees for 2013. It includes a new policy to pay a patient’s physician or practitioner to coordinate the patient’s care in the 30 days following a hospital or skilled nursing facility stay. Recognizing the work of community physicians and practitioners in treating […]
CMS finalized the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) rule on November 1, 2012, updating Medicare payment policies and rates for hospital outpatient and ASC services beginning January 1, 2013. The final OPPS/ASC rule with comment period affects hospital outpatient departments in more than 4,000 hospitals, including general acute […]
RAC Focus: Coding & Documentation of CHF
RAC Focus: Automated Denials
The state of Washington will become the first state to partner with the Centers for Medicare and Medicaid Services (CMS) in the Financial Alignment Demonstration to test a managed-fee-for-service model for providing Medicare-Medicaid enrollees with a more coordinated, person-centered care experience. Through the Demonstration, Washington will use a managed-fee-for-service care model that will build upon […]
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