Tag Archives: CMS

CMS Prohibits Cigna Unable to Sign New 2017 Medicare Beneficiaries

Cigna is not able to sign up new Medicare members for the 2017 enrollment period due to ‘widespread and systemic failures‘ in how Cigna administers coverage and benefits.  While other insurers have also faced similar allegations, Cigna is an outlier in that they have yet to remedy the deficiencies.

Will this have any impact on Anthem’s acquisition plans for Cigna?

Read more here.

CMS to End ICD-10 Coding Flexibility for Medicare Providers

One of the concessions CMS made to the provider community last year in an attempt to quell anymore calls for further ICD-10 compliance date delays was to provide a one year grace period from claims rejection if the ICD-10 filed on the claim was not coded to the highest specificity.  That did not mean the provider could just slap on any diagnosis code (e.g. a generic diabetes diagnosis when the patient presented w/a stubbed toe and was not diabetic) as the provider still had to have accurate medical documentation from the encounter.  The provider had to be w/in the family of codes.  For instance, in the above diabetes example, the provider could possibly code w/in the diabetes category (the first three digits of the diagnosis code) but not drill down to the most specific code based on the encounter.

The one year grace period is coming to an end.  CMS has announced an update to the Q&A where they announced the coding flexibility last year.  There is no leeway on extending this.

Read more here.

CMS Proposal to Add More Bundled Payment Programs

CMS recently submitted a proposal to add cardiac care to the successful bundled payment program it instituted in recent years to shift reimbursement towards quality measures and away from fee-for-service payments.  Reactions so far from the industry have largely been positive and expected from CMS.  Providers are gearing up for private payers to follow suit.