Tagged with Laboratory
New Jersey, Pennsylvania, Rhode Island – UHC Genetic and Molecular Lab Testing Notification Requirement
UnitedHealthcare will soon require providers in New Jersey, Rhode Island, and Pennsylvania to complete the notification/prior authorization process for genetic and molecular testing performed in an outpatient setting.
CMS Issues Pre-publication Notice for CLIA Proficiency Testing Regulations Related to Analytes and Acceptable Performance
CMS has posted a pre-publication notice announcing that they are extending the comment period for the previously proposed rule “Clinical Laboratory Improvement Amendments of 1988 (CLIA) Proficiency Testing Regulations Related to Analytes and Acceptable Performance”.
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.
Federal Judge Rules ACA is Unconstitutional
A federal judge in Texas has ruled that the entire Affordable Care Act (ACA) is unconstitutional on the grounds that its mandate requiring people to buy health insurance is unconstitutional and the rest of the law cannot stand without it.
UHC Network National Laboratory Services Care Providers for 2019
In 2019, UnitedHealthcare (UHC) will be growing its national network of participating laboratory providers to better support members and the care providers who order laboratory services.
Aetna Update for CPT II Codes for High Blood Pressure Measurements
Aetna has issued an update regarding the use of CPT II codes for HEDIS® high blood pressure measurements for patients diagnosed with hypertension.
Humana Claim Payment Policy Update
Humana has published a new claim payment policy update for durable medical equipment (DME) repair and replacement.
Connecticut – Provider Termination Requirements
Aetna has posted a reminder regarding provider contract termination requirements in the state of Connecticut.
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.
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 Introduces New Cost Comparison Tool
In an effort to improve healthcare price transparency, CMS launched a tool that allows consumers to compare Medicare payments and copayments for certain procedures that are performed in both hospital outpatient departments and ambulatory surgical centers.
Delaware Governor Announces Health Care Spending; Quality Benchmarks
Delaware Governor recently signed an executive order establishing state health care spending and quality benchmarks beginning in calendar year 2019.
Illinois Legislature Overrides Veto of Short-Term Health Plan Limit
State legislators in Illinois have voted to override the Governor’s veto of a bill intended to place restrictions on short-term health insurance plans sold in in the state, which are exempt from offering certain protections required under the Affordable Care Act (ACA).
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.
