Tagged with ICD-10 Diagnosis Coding

UnitedHealthcare – Coordinated Commercial Reimbursement Policy Updates

Beginning in July, UnitedHealthcare (UHC) will make changes to some commercial reimbursement policies, including after hours and weekend care, intraoperative neuromonitoring, and its professional and technical component policy for duplicate or repeat services of global test only.

UHC Manipulation Under Anesthesia Medical Policy Update

UnitedHealthcare (UHC) has released updated coverage rationale for manipulation under Anesthesia policy with updated language, updated and reformatted list of applicable ICD-10 diagnosis codes, as well as supporting information to reflect the most current clinical evidence and references.

2019 Medicare Advantage and Part D Rates Announced

CMS has released the final policy and payment updates to the Medicare Advantage (MA) and Part D programs for 2019. The policy changes for the coming year will include a pay increase for MA plans and strategies to increase the use of encounter data to determine risk scores for plans.

CMS 2019 Medicare Advantage Part I Advance Notice Released

CMS has released Part One of the 2019 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part D Payment Policies, containing proposed changes to the Part C Risk Adjustment Model and the use of encounter data.

Aetna Clinical Payment, Coding and Policy Updates

Aetna has released updated clinical, payment and coding policies, including multiple procedure reduction for diagnostic cardiology, diagnostic ophthalmology, and therapeutic services.

Cigna Requirement to Precertify Oncology Medications

Cigna has implemented an integrated oncology management program which requires providers to precertify certain medical oncology medications through a national ancillary provider (instead of Cigna), including primary chemotherapy, and supportive drugs, such as medical injectables and infusions.