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Medicare Advantage Organizations (MAOs) were warned by federal health officials last week to issue an appealable organization determination when denying or recouping part or all of a payment from a non-contracted provider. The directive came in the form of a Centers for Medicare & Medicaid Services (CMS) memo obtained by…
Regulatory upheaval continues amid the ongoing COVID-19 pandemic. A series of MLN Matters articles posted to the Centers for Medicare & Medicaid Services (CMS) website earlier this month covered a variety of topics, including, of particular note, a rundown of changes made by the October 2020 update of the Ambulatory…
Appeals court rules HHS has the authority to reduce payments. In November of last year, the Centers for Medicare & Medicaid Services (CMS) decided to move forward with a two-year phase-in of site-neutral payments, despite a decision in court earlier in the year siding with hospitals in their fight to…
The pandemic disrupted the stability surrounding food, shelter, and sleep. Because Healthfirst has long supported the health needs of underserved New Yorkers, we understand the impact of the social determinants of health (SDoH) on the underemployed, financially challenged seniors, and underrepresented minorities. During the ongoing COVID-19 pandemic, we had a…
The flu season is coming. There has been much discussion about COVID-19 this year, but as autumn approaches, thoughts turn towards influenza season. The Advisory Committee on Immunization Policies (ACIP) recently published guidelines for flu vaccination. Their advice is that routine annual vaccination is recommended for everyone 6 months of…
Action applies to the Medicare Accelerated and Advanced Payment Loan Program. In March, the Centers for Medicare & Medicaid Services (CMS) expanded the Accelerated and Advanced Payment Program (AAP) due to the COVID-19 public health emergency (PHE), in an effort to increase cash flow to providers. Under the current terms, repayment for…
On Sept. 8, the American Medical Association (AMA) released two new codes related to the coding and reporting of COVID-19 testing and management. The additions include one new code in the Pathology and Laboratory sections and one new code in the Medicine section of CPT. A summary of the new…
The Coordination and Maintenance Committee meetings were held virtually on Sept. 8 and 9. For proposals presented for an April 1, 2021 effective date, comments are due by Oct. 9, 2020. For proposals presented for an Oct. 1, 2021 effective date, comments are due by Nov. 9, 2020.  Comments may…