Category: Medicare

Medicare Announces Rule to Protect Consumers from Surprise Medical Bills

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Announcement is the first in a series of regulations aimed at shielding patients from increased financial hardships stemming from surprise medical bills

The Biden-Harris Administration, through the U.S. Departments of Health and Human Services (HHS), Labor, and Treasury, and the Office of Personnel Management, issued “Requirements Related to Surprise Billing; Part I,” an interim final rule that will restrict excessive out of pocket costs to consumers from surprise billing and balance billing. Surprise billing happens when people unknowingly get care from providers that are outside of their health plan’s network and can happen for both emergency and non-emergency care. Balance billing, when a provider charges a patient the remainder of what their insurance does not pay, is currently prohibited in both Medicare and Medicaid. This rule will extend similar protections to Americans insured through employer-sponsored and commercial health plans.

Please click on these links for more information   Consumer Protection  / What you need to know

CMS TO RESUME MEDICARE AUDITS AND PRIOR AUTHORIZATIONS

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The U.S. Centers for Medicare & Medicaid Services (CMS) will resume Medicare claims audits and prior authorization for power mobility devices and support surfaces on Aug. 3, according to an update to its FAQ on COVID-19 provider burden relief

Durable Medical Equipment, Prosthetics, Orthotics and Supplies: CMS Flexibilities to Fight COVID-19

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The Trump Administration is issuing an unprecedented array of temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic. Waivers include key categories such as Patients Over Paperwork, Prior Authorization in DMEPOS, Signature requirements, Accelerated/Advanced payments and Medicare appeals in Fee for Service, Medicare Advantage (MA) and Part D. For more information on the COVID-19 Pandemic please click on this link

MEDICARE TELEMEDICINE HEALTH CARE PROVIDER FACT SHEET

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The Centers for Medicare & Medicaid Services (CMS) has broadened access to Medicare Telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. These policy changes build on the regulatory flexibilities granted under the President’s emergency declaration. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act. Please click on this link for more information.

The Centers for Medicare and Medicaid Services (CMS) has released the 2018 Medicare DMEPOS fee schedule

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The Centers for Medicare and Medicaid Services (CMS) has released the 2018 Medicare DMEPOS fee schedule which will be effective for Medicare claims with a date of service on or after January 1, 2018. The 2018 Medicare fee schedule for orthotic and prosthetic services will be increased by 1.1% over 2017 rates.

The 1.1% increase is a net reflection of the 1.6% increase in the Consumer Pricing Index for Urban Areas (CPI-U) from June 2016 through June 2017, combined with the annual Multi-Factor Productivity Adjustment (MFP) of -0.5%. The 1.1% increase in the O&P Medicare fee schedule for 2018 represents a 0.4% larger amount than the 2017 increase of 0.7%. Unfortunately, the 2% sequestration based reduction to all Medicare payments remains in effect (currently through 2025) meaning that Medicare fee for service payments will continue to be reduced by 2% due to sequestration. While sequestration continues to impact Medicare reimbursement, it is not cumulative. You will still receive 1.1% more for a service you provide in 2018 then you did in 2017 since the 2% sequestration reduction would be applied to both claims.   Please click on the link to download the 2018 DMEPOS Fee Schedule  https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSFeeSched/DMEPOS-Fee-Schedule.html