Here are three of the new payer rules that took effect Jan. 1:
1. Blue Cross Blue Shield of Massachusetts no longer covers monitored anesthesia for certain gastrointestinal patients undergoing endoscopic, bronchoscopic or interventional pain procedures. Monitored anesthesia is no longer considered “medically necessary” for these procedures unless a patient receives documentation by the operating physician or anesthesiologist/certified registered nurse anesthetist that specific risk factors or significant medical conditions are present.
2. Blue Cross Blue Shield of Massachusetts removed 14,000 prior authorization requirements for home care services for its 2.6 million commercial members.
3. CMS expanded its Transparency in Coverage rule. Payers’ price comparison tools are now required to include all services, including prescription drugs. Payers not in compliance could face fines of up to $100 per day for each violation.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.