Tagged with Medical Billing Compliance
2022 Healthcare Cybersecurity Predictions and 3 Steps to Take Now
2022 Healthcare Cybersecurity Predictions look a lot like 2021, but with more risk on all fronts. 3 actions to take now can reduce your risk.
5 Coding Compliance Questions for Medical Billing Companies
Is your medical billing company on top of coding compliance and education? Use our 5 coding compliance questions to find out.
Mental Health Parity in the News
While mental health parity often takes a back seat in behavioral health billing, recent news shows that it has not been forgotten.
$8.3B Coronavirus Funding Bill Approved
During the first week in May, the U. S. House and Senate approved an $8.3 billion funding bill to support ongoing efforts to combat COVID-19 (Coronavirus). On March 6, the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (H.R. 6074) was finalized by the president
Ohio Revises Definition of Ambulatory Surgical Facilities
Ohio has released the recently revised definition of an Ambulatory Surgical Facility (ASF), as part of the new 2020/2021 general operating budget legislation. The change expanded the ASF definition, which may require some previously unlicensed facilities to obtain licensure.
Comprehensive CJR Model Proposed Extension and Changes
On February 20, CMS issued a proposed rule which recommends a three-year extension and changes to the episode definition and pricing in the Comprehensive Care for Joint Replacement (CJR) Model.
Anthem Outpatient Facility Edit Implementation
Effective April 26, Anthem Blue Cross Blue Shield (Anthem) will make changes to its outpatient facility edits for revenue codes, CPT® codes, HCPCS and modifiers. These edits will include changes to appropriate use of various code combinations, such as, procedure code to revenue code, HCPCS to revenue code, type of bill to procedure code, type of bill to HCPCS code, procedure code to modifier, and HCPCS to modifier.
Humana Claims Payment and Medical Coverage Policy Updates
Humana has published new and recently updated claim payment policies, including new policies for inpatient readmission review, modifiers CO and CQ, as well as revisions to the insurer’s chronic care management and principal care management and telehealth services policies.
Anthem CT Posts Advanced Imaging Clinical Appropriateness Guideline Updates
Anthem Blue Cross and Blue Shield (Anthem) of Connecticut (CT) released certain updates to its Vascular Imaging Clinical Appropriateness Guidelines which includes new and updated language for indication of asymptomatic enlargement by imaging and clarifying surveillance intervals for stable aneurysms.
Anthem Ohio Clinical Laboratory Improvements Amendments
Beginning May 1, claims that are submitted to Anthem Blue Cross and Blue Shield (Anthem) of Ohio for laboratory services subject to the Clinical Laboratory Improvement Amendments (CLIA) 1988 federal statute and regulations will require additional information to be considered for payment.
CMS Announces Plans to Change Prior Authorization Rules
CMS Administrator, Seema Verma, on February 11, announced the agency’s intent to reform prior authorization regulations later this year. According to Verma, the changes “will reduce administrative waste, increase patient safety and free physicians to spend time caring for their patients.”
CMS Develops New Code for Coronavirus Lab Test
On February 13, CMS introduced a new code that enables labs conducting Coronavirus tests to bill for the specific test instead of using an unspecified code.
UnitedHealthcare Implements Enhancements to Procedure to Modifier Policy
UnitedHealthcare has announced plans to implement certain changes to enhance the Procedure to Modifier Policy for Medicare Advantage plans to include modifiers CT, FX and FY.
New York Updates Quality Measures for Medicaid Managed Care Organizations in the Value Based Payment Program
The New York Department of Health released the 2020 value-based payment (VBP) Reporting Requirements Technical Specifications Manual for Measurement Year (MY) 2019. The report includes an overview of the specific quality measure reporting requirements for each VBP arrangement, as well as a description of the changes to the measure sets from 2018 to 2019.
Cigna Clinical, Reimbursement, and Administrative Policy Updates
Cigna has released its latest clinical, reimbursement, and administrative policy updates, which includes policy updates for certain anesthesia services, care integration services, and E & M services.
Aetna HCPCS Code Updates to Specific Drug Contract Service Groupings
Effective March 1, Aetna will implement code updates under which individual service codes will be assigned within contract service groupings. Changes to an individual provider’s compensation will depend on the presence or absence of specific service groupings within the contract.
CMS Publishes FY 2022 SNF APU Overview Table
CMS, on January 30, published the Fiscal Year (FY) 2022 Skilled Nursing Facility (SNF) Annual Payment Update (APU) table, indicating the data elements the agency will use for FY 2022 SNF Quality Reporting Program APU determinations.
CMS Issues Additional Guidance on D-SNP Integration Requirements
On January 17, CMS issued a memorandum providing additional guidance clarifying Medicare-Medicaid integration requirements for Dual Eligible Special Needs Plans (D-SNPs). The memorandum is intended to clarify distinctions between fully integrated D-SNPs (FIDE SNPs) and highly integrated (HIDE SNPs); permissibility of carve-outs of behavioral health services and long term services and supports (LTSS) for FIDE SNPs and HIDE SNPs; alignment of D-SNP and companion Medicaid plan service areas; and compliance with integration requirements for DSNPs that only enroll partial-benefit dually eligible individuals.
UHC Issues New ED Professional E/M Policy
UnitedHealthcare (UHC) has announced that starting April 1, 2020, they will use a proprietary software program to evaluate all professional claims submitted for emergency department visits with the Level 5 evaluation and management (E/M) code 99285.
CMS, HHS Proposes Changes to Stark Law and Anti-Kickback Statute Reforms
On October 9, the Department of Health and Human Services (HHS) announced proposed changes that seek to modernize and clarify the regulations that interpret the Physician Self-Referral Law (the Stark Law) and the Federal Anti-Kickback Statute. The proposed rule has been designed to provide greater certainty for healthcare providers participating in value-based arrangements and providing coordinated care for patients. The proposed changes are intended to ease the compliance burden for healthcare providers across the industry while maintaining strong safeguards to protect patients and programs from fraud and abuse.
