In early August, AASM members across the country were contacted by UnitedHealthcare (UHC) regarding their new process for Advanced Notification and Prior Authorization Requirements for Polysomnography and Portable Monitoring for Sleep Related Breathing Disorders. The new process promotes the use of out of center sleep testing (OCST) and establishes an advance notification and/or prior authorization requirement for all in-center sleep testing.

The federal health reform law will arm Medicare anti-fraud teams with sophisticated tools and funding to better identify individuals seeking to profit from the program.

In an Aug. 20 news release, Aetna and Coventry Health Care Inc. announced an agreement under which Aetna will acquire Coventry in a transaction which is valued at $7.3 billion. As a result of the agreement, Aetna is expected to add over 5 million total members across their commercial businesses, Medicare Part D, Medicare advantage and Medicaid. It is estimated that the acquisition will close in mid-2013.

The Centers for Medicare & Medicaid Services (CMS) has announced that registration is open to suppliers interested in participating in Round 1 of the Recompete of the Medicare DMEPOS Competitive Bidding Program. The Competitive Bidding Program was mandated by Congress in 2003. It requires that current fee schedule methodology be replaced with a competitive bid process. Under this process, suppliers operating a particular competitive bidding area (CBA) submit bids for products. View the full article to find which competitive bidding areas are included in the recomplete.

On Aug. 1, the Centers for Medicare & Medicaid Services (CMS) released the Provider Compliance Interactive Map, which provides state-by-state information for organizations that monitor compliance for CMS. The map lists organizations' contact information including websites, email addresses and phone numbers. The map also provides brief descriptions of the types of monitoring performed by each organization.

The Centers for Medicare & Medicaid Services (CMS) is expected to publish a final rule which will announce a delay in the compliance date for ICD-10. As the AASM previously announced, CMS published a proposed rule in April which recommended a one-year delay to the implementation of ICD-10. The new date of compliance would be Oct. 2014. CMS solicited comment on the proposed delay.

The Department of Health and Human Services announced a new fraud prevention partnership comprised of both private and public players. The companies and public organizations have joined efforts to “share information and best practices in order to improve detection and prevent payment of fraudulent health care billings.” Specifically, Secretary Kathleen Sebelius and Attorney General Eric Holder identified a desire to share tips about schemes, billing codes and “geographical fraud hotspots” to encourage quick action. The partnership includes a number of large insurance plans as well as both the US Department of Health and Human Services and the US Department of Justice.

On July 18, Rep. Michael Burgess (R-Texas) introduced legislation to extend Medicare physician payment rates for one year. The bill, called the Assuring Medicare Stability and Access for Seniors Act of 2012, addresses projected cuts to overall payment described in the CY 2013 Medicare Physician Fee Schedule Proposed Rule. The proposed rule, published earlier this month, includes an almost 30% cut to the conversion factor, which is used to establish payment rates for all physician services under Medicare.

On Friday, July 6 the Centers for Medicare & Medicaid Services (CMS) published a proposed rule recommending changes to payment for the Medicare program for calendar year (CY) 2013. Recommendations made in the proposed rule will be reviewed and, based on comment from the public, may be finalized in the final rule which will be published in November.