Tagged with ICD-10 Diagnosis Coding
Effective July 1, Anthem will implement processing updates for service claims under certain programs, including radiation oncology and cardiology services, which require precertification through AIM Specialty Health® (AIM).
Anthem Blue Cross Blue Shield (Anthem BCBS) will soon implement changes to its clinical payment and coding policy for several services and procedures.
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.
Cigna has published a number of updates for its clinical, reimbursement, and administrative policies, including reimbursement policies for pharmacy and infusion services, cervical fusion, and cardiac ablation for supraventricular tachycardia.
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.
CMS has released the latest coding changes, revisions, and feedback to National Coverage Determinations (NCDs) in the 10th revision of the ‘International Classification of Diseases (ICD-10) and Other Coding Revisions.
Blue Cross and Blue Shield of Vermont (BCBSVT) has released the list of recently updated medical policies and the corresponding effective dates.
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.
CMS has published a decision memo finalizing its proposal to cover MRI scans for Medicare beneficiaries with implantable cardiac devices such as pacemakers and cardioverter defibrillators.
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.
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.
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.
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.