Tagged with CPT Coding

IL BCBSIL NDC Billing Update for Medicare Advantage Claims

Effective December 15, Blue Cross and Blue Shield of Illinois (BCBSIL) will implement edits to validate National Drug Code (NDC)s that are submitted on electronic and paper, professional and institutional Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) claims.

Aetna Clinical Payment, Coding and Policy Updates

Aetna has released updated clinical, payment and coding policy positions, including correct coding of hospital observation, critical care, admission and discharge services, changes to the assistant surgeon list and the pass-through billing policy.

Cigna Medical Policy Updates

Cigna has posted updates to specific medical and preventive care services policies, including its uniform billing editor, pharmacy and infusion services, and omnibus reimbursement.

2018 eCQM Value Set Addendum for EPs, ECs Released

CMS has released an addendum to the electronic clinical quality measure (eCQM) annual update specifications originally published in May 2017. This addendum updates eCQM value sets for the 2018 performance period for Eligible Professionals (EPs) and Eligible Clinicians (ECs).

UHC – Genetic and Molecular Testing Prior Auth. Requirement

Effective Nov. 1, UnitedHealthcare will start its online prior authorization/notification program for genetic and molecular testing performed in an outpatient setting for fully insured UnitedHealthcare Commercial Plan members. Providers requesting laboratory testing will be required to complete the prior auth. process as well as indicate the laboratory and test name for specific services.

Anthem Updates Assistant Surgeon Policy and Code List

Anthem has posted its updated Assistant Surgeon policy and code list to reflect CPT® and Healthcare Common Procedure Coding System (HCPCS Level II) coding changes for 2017 as well as updates based on American College of Surgeons (ACS) and CMS information.

CMS Releases Proposed 2018 Medicare Physician Fee Schedule (MPFS) and Outpatient Prospective Payment System (OPPS)

CMS has released two proposed rules regarding Medicare reimbursement and requirements. The 2018 Proposed Medicare Physician Fee Schedule (MPFS) Proposed Rule addresses Medicare payment and quality provisions for physicians in 2018 and the 2018 Proposed Update to the Outpatient Prospective Payment System (OPPS) will update the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program.

CMS 2018 MA, Part D Final Payment Rates Announced with 0.45% Increase

CMS has released 2018 Medicare Advantage and Part D payment rates, announcing a 0.45% average rate increase. According to CMS, the changes made aim at providing benefit flexibility and efficiency which will allow Medicare enrollees to choose the care that best fits their health needs.

OH – Medicaid Oversight Committees Announce Changes to State Behavioral Health Redesign

The Ohio Department of Medicaid (ODM) and Ohio Department of Mental Health and Addiction Services (OhioMHAS) has announced two major policy and operational updates related to Behavioral Health Redesign. These policy modifications include the expansion of MH Day Treatment service for Qualified Mental Health Specialists (QMHSs) as well as the removal of the limit of 24 hours for Mental Health or SUD Nursing services per patient, per calendar year.

DOJ v. UnitedHealth

The DOJ moves forward with legal action against two insurers accused of erroneous coding and inflated billing – UnitedHealth and WellMed Medical Management.

CMS Releases Final 2017 Physician Fee Schedule

CMS has issued the final rule updating the Medicare’s physician fee schedule for 2017. Under the final rule, physician payment rates increase slightly, as called for by the Medicare Access and CHIP Reauthorization Act.

CMS Offers Revised Q&A for End of ICD-10 Grace Period

As of October 1, the year-long grace period for ICD-10 claims submissions has ended. To assist coders and hospitals, CMS has revised its Q&A “Questions and Answers Related to the July 6, 2015, CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities.”