Tagged with ICD-10 Diagnosis Coding
Telehealth Benefits Temporarily Expanded
The White House has announced that beginning on March 6, Medicare administered by CMS will temporarily pay clinicians to providing virtual visits and other telehealth services to beneficiaries.
CPT® Releases New Coronavirus (COVID-19) Code & Description for Testing
A new CPT® code has been created that streamlines novel coronavirus testing offered by hospitals, health systems and laboratories in the United States. The new code became effective March 13, 2020 for use as the industry standard for reporting of novel coronavirus tests across the nation’s health care system.
CDC Releases ICD-10 Official Coding Guidelines Related to COVID-19
The Centers for Disease Control (CDC) has released official diagnosis and coding guidance for health care encounters and deaths related to the 2019 novel coronavirus (COVID-19).
Humana Issues Provider Resources for COVID-19
Humana has created a space for providers to access information regarding diagnosis codes and claims, telehealth, and other administrative processes concerning COVID-19.
Ohio Revises Definition of Ambulatory Surgical Facilities
Ohio has released the recently revised definition of an Ambulatory Surgical Facility (ASF), as part of the new 2020/2021 general operating budget legislation. The change expanded the ASF definition, which may require some previously unlicensed facilities to obtain licensure.
CMS Develops New Code for Coronavirus Lab Test
On February 13, CMS introduced a new code that enables labs conducting Coronavirus tests to bill for the specific test instead of using an unspecified code.
CMS Releases 2021 MA and Part D Advance Notice Part II
On February 5, CMS released Part II of the Calendar Year (CY) 2021 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies. In the CY 2021 Advance Notice, the agency is proposing updates and changes to the methodologies used to pay MA plans, Programs of All-Inclusive Care for the Elderly (PACE) organizations, and Part D sponsors.
FDA Issues Gene Therapy Guidances
On January 28, the FDA issued six final guidances on gene therapy manufacturing and clinical development of products, as well as a draft guidance, describing the agency’s proposed approach to determining sameness of gene therapy products for orphan drug designation and exclusivity purposes.
CMS Publishes FY 2022 SNF APU Overview Table
CMS, on January 30, published the Fiscal Year (FY) 2022 Skilled Nursing Facility (SNF) Annual Payment Update (APU) table, indicating the data elements the agency will use for FY 2022 SNF Quality Reporting Program APU determinations.
2021 Proposed Changes for Evaluation and Management Services
By Marie Franklin, MBA, National Director of Coding, Education, and Audit The proposed new rules for 2021 will focus on medical decision-making or time as the determining factor when selecting the appropriate level for service rendered for all physicians for evaluation and management. Currently, Medicare has not made Medical Decision Making (MDM) as one of…
Aetna Issues Notice of Pay Percent Reduction for Multiple Endoscopies
Aetna has issued a notice, informing providers that, at the end of this year, the insurer will adjust payment for multiple endoscopy procedures in the same family.
Humana Releases Latest Claims Payment Policy Updates
Humana has published its latest medical claims payment policy updates, including its reimbursement policy for ambulance transportation, requirements for billing and documentation of observation services, as well as a new policy for obstetric billing, including antepartum, delivery and postpartum care.
UnitedHealthcare Expands Prior Auth Requirements and Site-of-Service Medical Necessity Reviews for Certain Surgeries
UnitedHealthcare has expanded prior authorization requirements and site of service medical necessity reviews for certain surgeries in an effort to shift surgical procedures to less expensive locations.
Executive Order Issued to Protect Traditional Medicare and MA Plans
The president, on October 3, signed an executive order directing the Department of Health and Human Services to increase efforts to provide more insurance plan options under Medicare Advantage and to remove regulations that are considered burdensome to health care providers. The order is intended to protect traditional Medicare and private Medicare Advantage while ramping up alternative payment models, time spent with patients, access to innovative technology and reducing the regulatory burdens on providers.
Improper Payment for Intensity-Modulated Radiation Therapy Planning Services
In a recent report, the Office of Inspector General (OIG) determined that payments for outpatient Intensity Modulated Radiation Therapy (IMRT) did not comply with Medicare billing requirements. Specifically, hospitals billed separately for complex stimulations when they were performed as part of IMRT planning. Overpayments occurred because hospitals are unfamiliar with or misinterpreted CMS guidance.
Anthem Blue Cross Blue Shield Clinical, Medical, and Coding Updates
Anthem BCBS has posted its recent Clinical, Medical, and Coding Updates, including revisions to Gene Therapy for Spinal Muscular Atrophy guidelines and changes to Positron Emission Tomography (PET) guidelines.
Cigna Preventive Care Services Policy & Precertification Updates
Cigna has made several additions and removals to its precertification list, as well as updates to its Preventive Care Services Policy.
UHC Updates Requirements for Specialty Medical Injectable Drugs
Effective October 1, 2019, Optum will make changes to and start managing prior authorization requests and processes for certain medical benefit injectable medications for UnitedHealthcare (UHC) commercial plan members.
New Jersey – UHC Outpatient Injectable Cancer Therapy Prior Authorization Requirement
Effective October 1, an affiliate company of UnitedHealthcare (UHC), will begin managing the insurer’s prior authorization requests for outpatient injectable chemotherapy and related cancer therapies for (UHC) Community Plan members in New Jersey.
Anthem Connecticut Introduces New Prior Auth Pass Program
Anthem is introducing a new program to reduce the administrative burden associated with current prior authorization (PA) processes for providers who are contracted with Anthem in Connecticut. The Prior Auth Pass Program allows providers who meet program requirements to waive prior authorization for select outpatient medical procedures that generally have high rates of PA requests and approvals.