Tagged with ICD-10 Diagnosis Coding
Anthem has released an update regarding the coding of bundled services for continuous intraoperative neurophysiology monitoring, from outside the operating room.
Humana has published a new claim payment policy update for durable medical equipment (DME) repair and replacement.
Anthem has posted several reimbursement policy updates, including updates to its Rule of Eight” Reporting Guidelines, system updates for 2019, and updates to policy for Modifier 69.
Anthem Wisconsin has updated certain medical policies and clinical utilization management (UM) guidelines to support clinical coding edits.
On November 1, CMS issued the Calendar Year (CY) 2019 Medicare Physician Fee Schedule (PFS) final rule. The final rule updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2019.
CMS has finalized Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) rates and policies for calendar year 2019.
CMS has released its final 2019 Medicare clinical laboratory fee schedule (CLFS) payment determinations for new and reconsidered clinical lab test codes. Specifically, CMS finalized the basis for establishing the payment rate (crosswalking or gapfilling), along with the agency’s rationale for the decision.
Anthem is updating its editing systems to automate edits supported by correct coding guidelines, as documented in industry sources such as CPT®, HCPCS Level II, and ICD-10. Anthem states the enhanced editing automation will promote faster claim processing and reduce follow-up audits and/or record requests for claims not consistent with correct coding guidelines.
CMS has released its October addenda, providing fourth quarter updates to the ASC payment system.
CMS and the National Library of Medicine (NLM) has published the most recent updates to the electronic clinical quality measure (eCQM) value sets. The updated sets include ICD-10 Clinical Modification (CM) and Procedure Coding System (PCS), SNOMED CT, LOINC, and RxNorm.
Effective April 1, UnitedHealthcare (UHC) will require care providers to submit a notification for injectable chemotherapy for members located in Wisconsin when it is administrated in an outpatient setting for UHC Medicare Advantage (MA) members with a cancer diagnosis.
The American Medical Association (AMA) and the American Society of Addiction Medicine (ASAM) have announced plans to pilot test a model that includes medications combined with psychosocial support.
CMS will remove the prior authorization (PA) requirement for certain types of medical equipment that no longer meet standards set forth in a 2015 final rule.
Effective July 1, Aetna will implement changes to its clinical payment and coding policies as well as several changes to its National Precertification List (NPL).
As of March 1 for UnitedHealthcare (UHC) Medicare Advantage (MA) members in Florida and Georgia and April 1 for plans in Wisconsin, UHC will require care providers to submit a notification for injectable chemotherapy when administrated in an outpatient setting for UHC MA members with a cancer diagnosis.
The New Jersey Department of Health is seeking to further expand inpatient treatment capacity for individuals battling mental health issues and drug addiction and has invited providers across the state to submit plans to add up to 53 more inpatient beds in the underserved regions of the state.
Aetna has made adjustments to five clinical payment, coding policies that will become effective on March 1st.
The federal agency responsible for the use of the ICD-10 in the United States, the National Center for Health Statistics (NCHS), has released an updated version of the ICD-10-CM for 2018.
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 has released updated clinical, payment and coding policies, including multiple procedure reduction for diagnostic cardiology, diagnostic ophthalmology, and therapeutic services.