Tagged with CPT Coding

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.”

New HCPCS Codes Now Effective

In the most recent quarterly update, CMS HCPCS code additions and changes affect drugs, biosimilars and biologicals.

Humana Updating Surgery Claim Processing Edits

Effective September 19, Humana will update claim processing edits for Surgery procedures, including: sigmoidoscopy, colonoscopy, other medical and surgical service during the postoperative period, FL Medicaid services included in delivery, birth center non-covered services, Florida Medicaid, and extracorporeal photopheresis.

Aetna Updates 99285 Edits

Effective December 1, Aetna will update its ER level of care policy for CPT code 99285 will downcode 99285 used with a designated minor diagnosis code.

Humana Updating Internal Medicine Claim Processing Edits

Effective September 19, Humana will update claim processing edits for Internal Medicine procedures, including: Sequential IV push, Telephone assessment and management, Home visit, Polysomnography, and Immune globulin.

Humana Updating Anesthesia Claim Processing Edits

Effective September 19, Humana will update claim processing edits for Anesthesia procedures, including: Medical supervision and medical direction of anesthesia services, Consistency of reduced or discontinued anesthesia services between professional and facility providers, Discontinued anesthesia services between professional and facility providers, and Anesthesia for colorectal cancer screening.

Humana Updating Lab/Pathology Claim Processing Edits

Effective September 19, Humana will update claim processing edits for Lab / Pathology procedures, including: prenatal screening, Independent Labs – Covered Services and frequency limits, and services included in prenatal care.

Humana Updating Radiology Claim Processing Edits

Effective September 19, Humana will update radiology claim processing edits, including: procedure code guidelines policy, obstetric ultrasound frequency,Zika virus, radiation treatment delivery, computed tomographic colonography, consultation on x-ray, magnetic resonance spectroscopy, and radiological examination of the hips and lower extremities.