Tagged with ICD-10 Diagnosis Coding

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.

Indiana Medicaid Medical Policy Updates

Anthem BCBS of Indiana has issued notice of medical policy revisions approved by the Medical Policy and Technology Assessment Committee (MPTAC).

Aetna Clinical Payment, Coding and Policy Updates

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.

2018 eCQM Value Set Addendum for EPs, ECs Released

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).

AdvantEdge