EmblemHealth-New Claims Payment and Remittance Effective August 19, 2020

On Aug. 19, 2020, they will be implementing a new claims payment and remittance (CPR) service powered by ECHO Health, Inc. (ECHO) for Group Health Incorporated (GHI). Health Insurance Plan of Greater

HHS Provider Relief Fund Phase 2 General Distribution Now Accepting Additional Applicants

On July 31, 2020, HHS announced that certain Medicare providers would be given another opportunity to receive additional Provider Relief Fund payments

MACs Resume Medical Review on a Post-Payment Basis

Medicare Administrative Contractors (MACs) are resuming fee-for-service medical review activities.

Medicare-Include Multiple Dates of Service on Reconsideration Appeal Request

Suppliers may include multiple dates of service for the same beneficiary on one reconsideration request form instead of submitting separate reconsideration requests for each date of service.

Repayment of Accelerated and Advance Payments for Part B Providers Begins July 27th

For the first 120 days, claims should be submitted as normal. Claims will be processed by National Government Services and payments that were transmitted to the provider.

Medicare FFS Audits Resuming
August 3rd

CMS recently announced that it anticipates resuming audits on August 3, as related to CMS’ program integrity efforts. This decision was made based on states reopening regardless of the ongoing public health emergency status.

CMS Issues ABN Update

A new Fee-for-Service Advanced Beneficiary
Notification of Non-coverage (ABN) form is now effective, with an expiration date of June 30, 2023. The use of the old ABN (version 03/2020) will be considered invalid after Aug. 31, 2020.

MCR-Targeted Probe & Educate (TPE) Reviews Suspended

In response to COVID-19, Medicare has implemented the following actions pertaining to TPE reviews:

Proper Billing for Telehealth Services Claims

CMS received a high volume of paper CMS-1500 claim forms for telehealth services with dates of service during the PHE that they have to reject because they are improperly coded with two different POS codes on one claim.

Medicare-Article Revisions for July 1st, 2020

ICD-10 CODES THAT SUPPORT MEDICAL
NECESSITY: Added: ICD-10 diagnosis codes E08.610, E09.610, E10.610, and E11.610 to Group 2 Codes for L4631

UnitedHealthcare COVID-19 End Date and Billing Guidance

The following resources will help you quickly reference the effective dates for UnitedHealthcare’s temporary benefit, program and procedure changes related to COVID-19, as well as billing guidelines for services such as COVID-19 testing, treatment and telehealth.

Medicare-Article Revisions for June 2020

Due to the clinical findings and challenges presented by patients with COVID-19 the following diagnosis codes have been added to ICD-10 Codes that Support Medical Necessity.

House Votes to Ease Restrictions on Coronavirus Small Business Loans

The House passed a bill Thursday designed to give small businesses owners more flexibility in how they spend money from a key coronavirus aid program.

UnitedHealthcare is Waiving Cost Share for Medicare Advantage Members

UnitedHealthcare is waiving cost share (copays, coinsurance and deductibles) for UnitedHealthcare Medicare Advantage plan members for all covered office-based professional services performed by...

CMS’ Interim Final Rule-COVID-19

CMS distributed a new interim final rule (IFR) on April 30 that entailed more regulatory waivers and rule changes. These changes are meant to increase access to care and provide added flexibility to providers in delivering that care.

Modifier 95 as it Relates to Medicare Part B and COVID-19 Billing

Modifier 95 Defined: Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system.

Additional Funding from HHS

$50 billion of the Provider Relief Fund is allocated for general distribution to facilities and providers that billed Medicare in 2019,

CMS Reevaluates Accelerated Payment Program and Suspends Advance Payment Program

On April 26th, CMS announced that it is reevaluating the amounts that will be paid under its Accelerated Payment Program and suspending its Advance Payment Program

CMS Sets up Accelerated and Advanced Medicare Payments Due to Coronavirus

On Saturday, CMS detailed how providers can access accelerated or advanced Medicare payments under the new economic stimulus package.

CMS: Providers can Skip 2019 MIPS Reporting Due to Coronavirus Crisis

As part of the federal government’s response to the COVID-19 pandemic, CMS has announced relief measures for providers who are bound to participate in its quality reporting programs, including the

Medicare-Protect Yourself and Your Patients from COVID-19 Fraud/Scammers

Scammers may use COVID-19 as an opportunity to steal your identity and commit Medicare fraud. In some cases, they might tell you they'll send you a Coronavirus test

CMS Announces the 2020 Medicare Part B Deductible

On November 8, 2019, the Centers for Medicare & Medicaid Services (CMS) released the 2020 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs

Coronavirus Disease 2019 (COVID-19)- How to Protect Yourself

Medicare Beneficiary Identifiers (MBIs) should be used now to avoid claim and eligibility transaction rejects. Effective January 1, 2020, regardless of the date of service

LCD and Policy Revisions Summary-February 20, 2020

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Did You Know that the Medicare Part B Overpayment Form has been Retired?

Some providers are still using the retired Medicare Part B Overpayment Form. The new process for provider-initiated non MSP overpayments is as follows:

Accepting Payment from Patients with a Medicare Set-Aside Arrangement

Medicare is always a secondary payer to liability insurance (including self insurance), no-fault insurance, and workers’ compensation benefits.

CMS Audits and How They Affect
Podiatry-TPE Audits-DME

Targeted Probe and Educate (TPE) is one process that a Medicare Administrative Contractor (MAC) can utilize when providers are selected by Medical Review. The TPE review process includes three rounds of a prepayment probe review with education.

CMS Audits and How They Affect
Podiatry-Audits Conducted by SafeGuard Services UPIC

Audits are being conducted by SafeGuard a UPIC (Unified Program Integrity Contractor) contracted by CMS to help identify and investigate cases of suspected fraud and ensure Medicare payments are recouped

EHR Vendor Practice Fusion to Pay $145 Million for Illegal Kickback Opioid Scheme

Practice Fusion Inc., of San Francisco, will pay $145 million to resolve criminal and civil investigation into a kickback scheme involving the developer’s EHR software, according to a news release from the U.S. Justice Department.

Completion of Certificates of Medical Necessity (CMN) Annual Reminder-January 2020

Certificates of medical necessity, commonly known as CMNs, are documents used by the DME MACs to assist in gathering information about the medical necessity of an item.

Common EHR-Related Malpractice Problems

Many doctors are tempted to copy a note from a prior encounter and make changes as appropriate. This leads to a few potential problems.

MIPS 2020

CMS released the 2020 Final Rule for the Quality Payment Program on Friday November 1, 2019. CMS made changes to performance thresholds, payment adjustments, and category requirements.

The Importance of Patient Relationship Categories and Codes (PRC)

Patient Relationship Categories and Codes (PRC) were established to help attribute patients and care episodes to physicians and other clinicians for measuring cost, particularly in the Quality Payment Program. Beginning in 2020

New Patient E/M Denials: Puzzle
Unraveled

New patient evaluation and management (E/M) claims are being denied when the patient was previously seen by a specialty physician assistant or specialty nurse practitioner on staff.

E/M 2021: Grasp the Future Roles of Time and MDM for Accurate Coding

Evaluation and management (E/M) code descriptors for office and other outpatient visits will look a lot different in the 2021 CPT code set.

E/M Changes Only to Office/Outpatient-Effective 2021 for 99202-99215

Medicare adopts CPT E/M changes for 2021, rescinding the plan for bundled payment for three levels of codes

Importance of 99024-Postoperative Visits

Code 99024 captures services normally included in the surgical package, indicating an evaluation and management (E/M) service was performed during a postoperative (post-op) period for reasons related to the original procedure.

Medicare-Top Reasons for Unprocessable Claims

Medicare has composed a list of the top reasons for returning claims as unprocessable; due to missing, incomplete, insufficient or invalid claim information.

Medicare Reminder: Providers on
Automatic Immediate Recoupments

If you are set up for automatic recoupments, please refrain from submitting checks and overpayment forms. Submitting receipts run the risk of money being offset and your check being applied to another open receivable.

Emblem Health - Preauthorization Codes Removed as of January 01, 2020

The following codes will no longer require pre-authorization as of January 01, 2020:

Medicare Provider Enrollment Application Fee for CY 2020

On November 12, CMS issued a notice: Provider Enrollment Application Fee Amount for Calendar Year 2020 [CMS–6089–N

United Healthcare-Prepare for Patients with Bind On-Demand Health Insurance

Effective Jan. 1, 2020, Bind on-demand health insurance will be available to all UnitedHealthcare employer groups across the nation.

New DMEPOS Order Requirements Effective January 01, 2020

Only one type of order is needed for DMEPOS claims with dates of service January 1, 2020 or after.