Federal Update: Requirements Related to Surprise Billing; Part 1
On July 1, the Biden administration released an interim final rule with comment period (IFC), “Requirements Related to Surprise Billing; Part I.” This is the first significant step to implementing the No Surprises Act, passed as part of the Consolidated Appropriations Act of 2021 (CAA) in December 2020. The No Surprises Act protects healthcare consumers, […]
Surprises in the No Surprises Act: New Requirements for Plans and Providers Regarding Provider Directory Information
Copyright 2021 Compliance Today, a publication of the Health Care Compliance Association (HCCA). The No Surprises Act was signed into law in December 2020 as part of the massive Consolidated Appropriations Act of 2021.[1] It is the end result of several prior bills that sought to address the national “surprise bill” problem. In recent years, millions […]
Key Application Dates: Unpacking The CMS Medicare Advantage Calendar
Centers of Medicare & Medicaid Services (CMS) Key Application Dates for CY 2022 Medicare Parts C and D Annual Calendar Our CMS calendar is one of the easiest ways to stay up-to-date with important dates and timelines for CY 2022 Medicare Advantage (MA) plans, Medicare Advantage-Prescription Drug (MA-PD) plans, Prescription Drug Plans (PDPs), Medicare-Medicaid Plans […]
Top 3 Things the “No Surprises Act” Means for Health Plans
It’s staggering to think that, according to researchers, one in five emergency room visits result in an individual receiving a bill for treatment or services they expected to be covered by their health plan, but weren’t. These unexpected, costly, and often frustrating charges are aptly called Surprise Medical Bills. While surprise medical bills impact consumers financially, […]
Insights on Price Transparency: Transparency In Coverage (CMS-9915-F)
On October 29, 2020, the Department of Health and Human Services (HHS), the Department of Labor, and the Department of Treasury released the final version of the Price Transparency Rule. The rule requires most private health plans (self-insured, ERISA), including group health plans and health insurance issuers to publicly disclose the rates they pay healthcare […]
New Metrics are Critical to Addressing Mental Health Access Concerns
Our new normal is far from normal. There is this level of incredible, nonstop uncertainty around our current situation, and none of us are immune. CDC data, collected in late June, noted an increase month-over-month in mental health issues. It showed that 40 percent of adults struggled with anxiety, depression, suicidal thoughts and substance abuse1. […]
Quest Analytics to Measure Adequate Access to Care for Medicare Advantage, Medicare-Medicaid and Pharmacy Plans
OVERLAND PARK, KS, September 15, 2020 – Quest Analytics, the leader in provider network accuracy and adequacy solutions announced today the Centers for Medicare & Medicaid Services (CMS) has extended their contract with Quest Analytics for an additional five-year term to measure the adequacy of all Medicare Advantage Part C & D and Medicare-Medicaid Health Plans’ (MMP) provider, […]
The Rebirth of Network Adequacy: Modernizing Health Plan Practice
Reprinted from The URAC Report. Nearly two months ago now CMS finalized changes to Medicare Advantage (MA) and Part D for 2021 and while I previously covered the new telehealth network adequacy provisions, I’ve been meaning to do a deeper dive into how network adequacy as a whole has changed in recent years. To do this, I reached out to Cari […]
Preparing for the Era of Provider Network Transparency
Copyright 2020 Compliance Today, a publication of the Health Care Compliance Association (HCCA). Transparency is one of the top buzzwords in healthcare today. In the last few years, we have seen the rollout of significant healthcare transparency initiatives focused on portable health records, hospital costs, drug costs, quality data, and many other things (e.g., Executive […]
Rule Raises Questions About Telehealth, Directory Accuracy
Reprinted with AIS Health permission from the July 2, 2020, issue of RADAR on Medicare Advantage. As Medicare Advantage and other insurers report increasing use of telehealth during the COVID-19 pandemic and consider the larger role that virtual visits could play on a more permanent basis, CMS recently finalized a set of policies for 2021 […]
