Tagged with CPT Coding
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 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.
Humana Correct Coding Update
Humana has updated it list of correct coding for certain procedure, effective July 6, 2017.
Harvard Pilgrim: Infliximab Medical Review Criteria Update
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.
Update on Reporting Global Codes Post-Operative Data
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 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 Proposes 0.25% Medicare Advantage Rate Increase
CMS has announced proposed changes to the Part D prescription drug program and Medicare Advantage for calendar year 2018.
