Medical Billing, Practice Management
and Consulting Company
This section provides the latest and essential industry updates as they become available.
Empire BlueCross BlueShield Update-Use of Modifier 25 for Billing for Visits that Include Preventive and Problem Oriented E&M Services
On January 1, 2023, Empire BlueCross BlueShield HealthPlus
(Empire) stated that they would begin to implement additional steps to review claims for Evaluation & Management (E/M) services submitted by providers
Amendment to the Calendar Year 2023 Fee Guidance for the Federal Independent Dispute Resolution Process Under the No Surprises Act: Change in Administrative Fee
This guidance amends the previous “Calendar Year 2023 Fee Guidance for the Federal Independent Dispute Resolution Process under the No Surprises Act” released on October 31, 2022
CMS Announces 6.4%-9.1% CPI-U Adjustments for DME in 2023-Significamt Increase in DMEPOS Fee Schedule
The Centers for Medicare & Medicaid Services (CMS) released the 2023 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Medicare fee schedule with an increase of 8.7 percent.
2022 Medicare Open Enrollment October 15th thru December 7th
Medicare’s Open Enrollment period gives people with Medicare the opportunity to make changes to their health plan or prescription drug plan, pick a Medicare Advantage plan, or return to Original Medicare (also referred to as Medicare Part A and Part B).
Excellus Blue Choice and Orthotics Denials
Recently, there has been an issue with Excellus BC/BS with the coverage of orthotics (HCPCS L3000). The problem is specifically for patients enrolled in their Medicaid
Managed Care plan (known as the Blue Choice Option where the patient’s ID number starts with VYT).
Medicare-August and September 2022 LCD, Billing & Coding Article Updates
Under the Limitations section, the active care requirement for systemic conditions has been revised to remove “qualified non-physician practitioners” to conform with the Centers for Medicare & Medicaid Services (CMS) Internet -Only Manual (IOM) Publication 100-02
How to Determine New vs. Established Patient
According to the CPT codebook, a “new” patient is, “one who has not received any professional services from the physician/qualified health care professional or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.”
CIGNA-Reimbursement Policy Update Regarding E&M Codes Billed with Modifier 25 and Minor Procedures Effective August 13, 2022
As a result of a recent review, CIGNA will require the submission of office notes with claims submitted with evaluation and management (E&M) codes 99212, 99213, 99214, and 99215 and modifier 25 when a minor procedure is billed.
2022 MIPS Extreme and Uncontrollable Circumstances Exception Application Now Open
MIPS eligible clinicians, groups, and virtual groups may submit an application to reweight any or all MIPS performance categories if they've been affected by extreme and uncontrollable circumstances that impact these performance categories.