Tagged with ICD-10 Diagnosis Coding
Aetna Wisconsin Issues New Preapproval Requirements for Members
Effective July 1, Aetna will require prior authorization for certain procedures under its Enhanced Clinical Review Program with eviCore healthcare.
UnitedHealthcare Washington Changes in Advance Notification and Prior Authorization Requirements
UnitedHealthcare (UHC) Washington has released a notice detailing which procedure codes will require prior authorization for UnitedHealthcare Community Plan of Washington, effective for dates of service on or after October 1.
UnitedHealthcare Issues Recent Commercial Reimbursement Policy Updates
Effective September 1, UnitedHealthcare (UHC) will add a new policy for molecular pathology and will make changes to its procedure to modifier policy.
Cigna Clinical, Reimbursement, and Administrative Policy Updates
Cigna has published a number of clinical, reimbursement, and administrative policy updates, including its reimbursement policy for spinal fusion related services, venous angioplasty, and orthotic prescriptions.
Anthem Posts Bundled Services and Frequency Editing Reimbursement Policies Updates
Beginning with dates of service November 1, Anthem will implement updates Bundled Services and Supplies and Frequency Editing reimbursement policies.
Aetna Issues New Radiation Therapy Preapproval Requirements
Beginning July 1, Aetna will require authorization for its enhanced clinical review program with eviCore healthcare for certain outpatient radiation therapy services.
ICD-10-CM Coding Changes Released for FY 2020
CMS has provided ICD-10-CM coding updates for the fiscal year, starting October 1, 2019 and ending September 30, 2020.
Anthem New Partial Hospitalization Program and Intensive Outpatient Program Services Facility Reimbursement Policy
Beginning with dates of service on or after July 1, Anthem Blue Cross and Blue Shield (Anthem) will implement the new facility reimbursement policy, Partial Hospitalization Program and Intensive Outpatient Program Services.
UnitedHealthcare Changes in Advance Notification and Prior Authorization Requirements
UHC has posted a correction to authorization previously published code additions, as well as new codes requiring prior authorization.
CMS Releases 2020 Medicare Advantage and Part D Rates
On April 1, CMS released its finalized payment and policy changes for Medicare Advantage (MA) and Medicare Part D plans for the 2020 coverage year. CMS states the final updates will continue to maximize competition among Medicare Advantage and Part D plans, as well as include important actions to address the nation’s opioid crisis.
CMS Takes Aim at Potentially Inappropriate Medicare Lab Test Billing
CMS has announced plans to analyze whether clinical labs improperly unbundled Medicare billing codes for panel diagnostic tests in order to receive higher payments.
Anthem BCBS Professional Bundled Services and Supplies Update
Anthem has released an update regarding the coding of bundled services for continuous intraoperative neurophysiology monitoring, from outside the operating room.
Humana Claim Payment Policy Update
Humana has published a new claim payment policy update for durable medical equipment (DME) repair and replacement.
New York – Anthem Reimbursement Policy Updates
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.
Wisconsin – Anthem Medical Policies and Clinical UM Guidelines Update
Anthem Wisconsin has updated certain medical policies and clinical utilization management (UM) guidelines to support clinical coding edits.
CMS Publishes Final CY 2019 Medicare Physician Fee Schedule Rates and Policies
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 Finalizes Medicare OPPS, ASC Rates and Policies for 2019
CMS has finalized Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) rates and policies for calendar year 2019.
CMS Finalizes 2019 Medicare Clinical Lab Payment Determinations
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 – Enhanced Automated Claim Edits
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.
Fourth Quarter ASC Payment Rate Updates Released
CMS has released its October addenda, providing fourth quarter updates to the ASC payment system.
