Tagged with CPT Coding
Beginning November 1, UnitedHealthcare (UHC) will require a new online notification/prior authorization process for genetic and molecular lab tests for their Commercial benefit plan members.
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 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 has posted updates to specific medical and preventive care services policies, including its uniform billing editor, pharmacy and infusion services, and omnibus reimbursement.
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).
A total of 314 code changes have been implemented throughout the 2018 CPT manual. Of these changes, Anesthesia will see four changes to observation E/M codes, the addition of five gastro-endoscopic procedure codes, and three low-volume codes have been deleted.
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 Blue Cross and Blue Shield released updated medical policies and clinical guidelines to be implemented on November 1, 2017 in certain states.
UnitedHealthcare Expands Prior-Authorization Requirement for Certain Office-Based Procedures Performed in Other Sites of Service
Beginning October 1, UnitedHealthcare will require notification/prior authorization for certain procedures when performed in any setting other than a physician’s office.
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.
Humana has updated it list of correct coding for certain procedure, effective July 6, 2017.
Harvard Pilgrim is updating commercial and StrideSM (HMO) Medicare Advantage medical review criteria for the medication infliximab (Remicade/Inflectra) to allow coverage for the CPT code.
Beginning July 1, CMS will require practitioners that are part of a group practice of ten or more that provides global services in certain states to report post-operative visits.
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.
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.
The DOJ moves forward with legal action against two insurers accused of erroneous coding and inflated billing – UnitedHealth and WellMed Medical Management.
CMS has announced proposed changes to the Part D prescription drug program and Medicare Advantage for calendar year 2018.
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.
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.”