Tag: Anthem
BCBS of Massachusetts warns against DME scams
October 19, 2022HME News Staff
BOSTON – Blue Cross Blue Shield of Massachusetts is warning members to be vigilant, as scams offering free DME and pharmacy products are on the rise. Medicare beneficiaries and patients who've had a recent injury or surgery are often targeted by scammers, it says. In many cases, the perpetrators solicit physicians to sign off on unnecessary orders or prescriptions, such as back braces or pain cream, which are then improperly billed to a patient's health insurer. "While these types of...
In brief: Medicare audits, Anthem rate cuts, NC win
July 10, 2020HME News Staff
WASHINGTON - Starting Aug. 3, auditors will restart their audit functions, according to a recently published FAQ from CMS.
If selected for review, HME providers should discuss with their contractor any COVID-19-related hardships they are experiencing that could affect audit response timeliness, states the guidance.
CMS says all reviews will be conducted in accordance with statutory and regulatory provisions, as well as related billing and coding requirements. Waivers and flexibilities in place...
Anthem declines to rescind rate cuts
July 9, 2020HME News Staff
WASHINGTON - Anthem does not plan to rescind rate reductions of 11% to 60% for HME, AAHomecare reports.The payer and its subsidiary, Amerigroup, implemented the cuts for its commercial and government plans in the 22 states it serves.AAHomecare had asked Anthem to delay the cuts during the COVID-19 pandemic, making a direct appeal to President and CEO Gail Boudreaux that included the results of a supplier survey about the impact of the pandemic.In a June 30 response, Anthem Vice President Leah Timmerman...
Anthem eyes steep rate cuts
June 4, 2020HME News Staff
WASHINGTON - Anthem and its subsidiary, Amerigroup, have proposed rate reductions of between 11% and 60% for home medical equipment, AAHomecare reports.
The proposed reductions would include commercial and government plans across 22 states, according to the association.
In a letter to Anthem President and CEO Gail Boudreaux, AAHomecare asks for a delay to the cuts, citing new cost structures due to the current public health emergency.
“This is a time of crisis for our country and our...
Stakeholders take aim
September 30, 2016Theresa Flaherty, Managing Editor
WASHINGTON - Industry stakeholders hope a recent meeting will open up a dialogue between Anthem Blue Cross Blue Shield and CPAP providers who have concerns with some of the insurer's requirements.
Of primary concern: Anthem's benefits management company, AIM Specialty Health, requires providers to supply proof of patient compliance quarterly for the first year of treatment and annually thereafter. That frequency level can create access issues, and possible medical complications,...
NCPA rejects 'merger mania'
September 10, 2015HME News Staff
WASHINGTON - The National Community Pharmacists Association (NCPA) supports today's hearing examining the consolidation in the healthcare marketplace, conducted by the House of Representatives Subcommittee on Regulatory Reform, Commercial and Antitrust Law. Of particular concern: the proposed Anthem-Cigna and Aetna-Humana mergers. “Policymakers cannot allow the 'merger mania' gripping the nation to proceed in a way that harms patients and the community pharmacists who serve them,”...
Private pay CPAP requirements go step further
November 9, 2012Theresa Flaherty, Managing Editor
YARMOUTH, Maine - A new sleep management program aimed at improving patient compliance for Anthem Blue Cross Blue Shield members could mean more paperwork for providers.
Two key facets to the program: Providers must submit prior authorizations for all sleep therapy-related equipment and supplies and renew them annually; and providers must document patient compliance quarterly for the first year, and then annually thereafter.
"We are trying to make sure that patients stay engaged over the long...