Tagged with Multi-Specialty-Billing
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.
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…
CMS, HHS Proposes Changes to Stark Law and Anti-Kickback Statute Reforms
On October 9, the Department of Health and Human Services (HHS) announced proposed changes that seek to modernize and clarify the regulations that interpret the Physician Self-Referral Law (the Stark Law) and the Federal Anti-Kickback Statute. The proposed rule has been designed to provide greater certainty for healthcare providers participating in value-based arrangements and providing coordinated care for patients. The proposed changes are intended to ease the compliance burden for healthcare providers across the industry while maintaining strong safeguards to protect patients and programs from fraud and abuse.
CMS Advances ‘Patients over Paperwork’ Initiative Under Final Rule
On September 26, CMS issued The Omnibus Burden Reduction (Conditions of Participation) Final Rule, which advances the ‘Patients over Paperwork’ initiative aimed at reducing administrative costs in healthcare.
Texas to Receive Increase in Federal Funds for Uncompensated Care
The Texas Health and Human Services Commission announced, on October 1, that the state will be given $11.6 billion over the next three years to help reimburse health care providers for indigent services and is intended to benefit hospitals, clinics, public ambulance, and dental providers.
House Ways and Means Committee Chairman Proposes New Approach to End Surprise Medical Bills
In a letter to the House Ways and Means Committee, Chairman Richard Neal has proposed that the Departments of Health and Human Services (HHS), the U.S. Labor and Treasury Department, along with other interested parties, consolidate their efforts to develop standards for rates for surprise bills.
Proposed Legislation Aims to Improve Provider Directories Accuracy
Two physician lawmakers have proposed new legislation that aims to improve the accuracy of information in health plan provider directories and protect patients from surprise out-of-network bills. The Improving Provider Directories Act (HR 4575) would require health plans to provide an avenue for people to report errors in provider directories, in a “highly visible way”.
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.
House Approves CR, Senate Unveils Draft HHS Bill
The House, on September 19, approved a short-term spending measure that will keep the government funded through mid-November and avoid a shutdown at the beginning of October. Additionally, the Senate, on the 18th, released the FY2020 subcommittee chairman’s recommendation for the Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS) Appropriations bill.
Federal Judge Overturns CMS Rule to Cut Medicare Payments to Outpatient Hospital Clinics
A U.S. District Judge has overturned a CMS rule that had reduced Medicare reimbursement rates for off-campus hospital clinic visits.
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.
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.
Aetna Wisconsin Issues New Preapproval Requirements for Members
Effective July 1, Aetna will require prior authorization for certain procedures under its Enhanced Clinical Review Program with eviCore healthcare.
UnitedHealthcare Washington Changes in Advance Notification and Prior Authorization Requirements
UnitedHealthcare (UHC) Washington has released a notice detailing which procedure codes will require prior authorization for UnitedHealthcare Community Plan of Washington, effective for dates of service on or after October 1.
Humana Posts New, Revised Medical Coverage Policies
Humana has released its most recent medical coverage policy changes, including one new policy and updates to its brachytherapy, genetic testing, and transcatheter valve procedures policies.
Cigna Clinical, Reimbursement, and Administrative Policy Updates
Cigna has published a number of clinical, reimbursement, and administrative policy updates, including its reimbursement policy for spinal fusion related services, venous angioplasty, and orthotic prescriptions.
Anthem Posts Bundled Services and Frequency Editing Reimbursement Policies Updates
Beginning with dates of service November 1, Anthem will implement updates Bundled Services and Supplies and Frequency Editing reimbursement policies.