Tagged with ICD-10 Diagnosis Coding
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.
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.
UHC has announced two updates for notification and prior authorization on certain procedures, as well as revisions to its emergency department facility evaluation and management (e/m) coding policies.
Humana has released two new medical coverage policies and several updates to policies effective at the start of the new year.
On March 1, 2018, UnitedHealthcare MA will require notification for injectable outpatient chemotherapy drugs given for a cancer diagnosis for members in Florida and Georgia.
Anthem BCBS of Indiana has issued notice of medical policy revisions approved by the Medical Policy and Technology Assessment Committee (MPTAC).
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.
Indiana Health Coverage Programs (IHCP) has released their annual update of the ICD-10 diagnosis and procedure codes.
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.
Massachusetts Medicaid administrator, MassHealth, is taking an innovative approach to control costs through implementation of a new health model that helps identify and address social determinants of health.
Humana released three Cardiology code edits that will be effective as of August 31, as well as significant revisions to certain medical coverage policies.
Cigna has released an update to its Electrical Stimulation Therapy and Devices policy and is also implementing a new policy, related services, supplies, drugs and equipment for claims processed on or after July 9, whether or not the supplies are billed with the device or separately.
Humana has updated it list of correct coding for certain procedure, effective July 6, 2017.
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.
Harvard Pilgrim has updated the Eylea Medical Policy to remove some codes that were not consistent with the policy’s intent and will now include ICD-10 codes newly released by CMS. In addition, the insurer says it will update its Standard professional fee schedule, incorporating recently released Medicare relative value units (RVUs) and laboratory rates for 2017.