Tagged with Surgery Billing News
Humana New, Revised Medical Coverage Policies Implemented
Humana has released its most recent medical coverage policy changes, including updates to its Code Compendium (Ophthalmology) and Laser Interstitial Thermal Therapy policies.
Humana Updates Preauthorization and Notification Lists for 2019
Humana has posted the recent updates to its preauthorization and notification.
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.
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.
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.
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.
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 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.
UnitedHealthcare Medical Policy Updates
UnitedHealthcare (UHC) has released its most recent medical policy updates for November 2018 which includes complete details on UHC medical policy, medical benefit drug policy, coverage determination guideline), utilization review guideline, and/or quality of care guideline updates, as well as new, updated, revised, replaced and retired health services policies.
