Stories written by Ellen Terry

Telemedicine Payments Promised, Regulations Eased - 04/02/2020

To help Texas physicians safely and effectively treat patients during the COVID-19 pandemic, several changes to telemedicine visits have taken effect, including payment for services and which platforms can be used.


Telephone-Only Consultation Coverage and Payment Vary - 03/31/2020

The use of telemedicine has been expanded so physicians can safely and effectively treat patients during the COVID-19 pandemic. However, some people don’t have smartphones with video capability, meaning visits will have to be done via old-fashioned phone calls. Which health plans cover telephone-only patient visits, and what exactly do they pay for?


AMA Creates CPT Code for Coronavirus Test - 03/17/2020

The American Medical Association has created a Current Procedural Terminology (CPT) code, 87635, to report laboratory testing services that diagnose the presence of the novel coronavirus.


Wage Rule Extends Overtime to More Employees - 02/07/2020

Some of your employees may have become newly eligible for overtime pay on Jan. 1. The U.S. Department of Labor has increased the minimum salary for exempt employees to $684 per week – $35,568 annually – from the previous level of $455 per week ($23,660 annually). Any employee earning less than $684 per week is automatically nonexempt and thus eligible for overtime pay.


UnitedHealthcare Out-of-Network Referrals: Prior Approval, Patient Consent - 02/05/2020

If you are a UnitedHealthcare (UHC) participating physician referring a patient out of network in a nonemergency, you’re now required to first obtain either (1) prior approval from UHC; or (2) the patient’s written consent.


You May Need to Refile Some Medicare Claims - 02/03/2020

Be on the lookout for Medicare claims you’ve filed since Oct. 1 in which procedure codes failed to process, causing a rejected claim. You will need to refile these claims.


Use New Medicare IDs to Avoid Rejected Claims - 01/07/2020

Your Medicare patients have ditched their old Medicare ID numbers. It’s high time you do, too, to avoid unpaid claims in the new year. Starting Jan. 1, Medicare beneficiary identifiers (MBIs) replace patients’ old Social Security number-based health insurance claim numbers (HICNs). Novitas Solutions, the Medicare payer for Texas, will reject any claim submitted with a patient’s HICN, with a few exceptions. You will have to refile the claim with the patient’s MBI to get paid.


Request UnitedHealthcare Peer-to-Peer Review Online - 01/02/2020

Seeking a peer-to-peer conversation after a preauthorization request was declined? Now you can request one through an online form available on UnitedHealthcare’s Prior Authorization and Notification webpage.


Apply by Dec. 31 for MIPS Reporting Exceptions - 12/17/2019

Did your practice face an unusual extreme hardship this year? Do you practice in a rural area with poor internet connectivity? If so, you could qualify for an exception to the Merit-Based Incentive Payment System (MIPS) reporting requirements for the 2019 performance year. The application deadline is Dec. 31.


Review Cigna Patient Feedback Before It Goes Public - 12/13/2019

Now is the time to preview your patients’ reviews that will appear in myCigna.com provider directories starting in early 2020 – or you can opt out of having your patient reviews published in Cigna’s directories.


Do Your Security Risk Assessment Before Dec. 31 - 11/13/2019

If you participate in the Medicare Merit-Based Incentive Payment System (MIPS), conducting or updating a risk assessment is a requirement in the Promoting Interoperability category. In order to meet the 2019 performance year requirements, you must complete your security risk assessment by Dec. 31. This is not an optional measure. Thankfully, an upgraded tool from the U.S. Department of Health and Human Services (HHS) might make the assessment easier.


Medicare Lab Fee Includes Routine Venipuncture - 10/16/2019

If you perform the lab test in your office, you may not bill separately for the “collection of venous blood by venipuncture,” or CPT code 36415, according to the Medicare Claims Processing Manual. However, a significant number of physicians who collect blood and perform lab tests in their office are billing for CPT code 36415 along with the test code, the Center for Medicare & Medicaid Services says.


Here’s What Medicare Pays for Flu Shots This Season - 10/04/2019

The Centers for Medicare & Medicaid Services recently published 2019-20 payment rates for personal flu vaccines and their administration. The effective dates for these rates are Aug. 1, 2019, to July 31, 2020.


Payers Axe Consultation Codes - 08/07/2019

Both Cigna and UnitedHealthcare (UHC) have announced that starting in October, they will no longer pay for CPT consultation codes 99241-99245 – office consultations – and 99251-99255 – inpatient consultations. UHC’s policy change becomes effective Oct. 1, as outlined in its March bulletin. Cigna’s July newsletter says Cigna’s policy takes effect Oct. 19.


Get Dates of Service Right on Medicare Claims - 05/30/2019

When you a perform a Medicare service that is global, has both a professional and a technical component, or spans days or months, you need to know what date Medicare considers to be the official date of service when you file your claim. Here is some guidance from the Centers for Medicare & Medicaid Services (CMS) about coding and billing dates of service on professional claims.


Doctor’s Order A Must For Lab Tests - 05/29/2019

The Centers for Medicare & Medicaid Services is paying attention to claims for these lab services because it has found they were paid in error in 2018 by some $28 million. For routine venipuncture, medical necessity errors accounted for virtually all the improper payments. For urinalysis, it was insufficient documentation.


Medicare Critical Care and Initial Hospital Services E and M Slated for Review - 05/17/2019

If you’ve been “probed and educated” twice by Novitas Solutions Inc. for high rate of claims errors regarding certain evaluation and management (E&M) services, you may receive more such review and education this summer.


Dos and Don’ts of Using Modifier 22 - 04/25/2019

Sometimes the work to provide a service is “substantially greater” than typically required on the date of services. When this happens, document the extra work by adding modifier 22 to the procedure code.


Charging Concierge Fees to BCBSTX Patients - 04/23/2019

Although Blue Cross and Blue Shield of Texas (BCBSTX) places limits on the additional fees participating network physicians can charge BCBSTX patients, some are allowed when you provide concierge services.


Go Paperless With UHC Document Vault - 04/22/2019

Looking for ways to reduce the amount of paper your practice uses? One way is to digitally receive claim and prior authorization letters for UnitedHealthcare commercial and Medicare patients through UHC’s Document Vault, rather than by mail.


Ambetter: New Required Field on CMS-1500 Claim Form - 04/18/2019

Ambetter from Superior HealthPlan, a plan available on the Affordable Care Act health insurance exchange, has changed the status of box 18 on the CMS-1500 claim form from a conditional/optional field to a required one, effective July 1.


Make Sure These Medicare Missteps Didn’t Affect Your Claims - 04/16/2019

Because of all of the policies, edits, determinations, rules, and revisions, Medicare’s claims processing sometimes goes awry for certain codes, fees, or other specific claim elements. The Centers for Medicare & Medicaid Services (CMS) reports these errors and their fixes on a regular basis.


Medicare Enrollment Application Revised - 03/04/2019

A new Medicare enrollment application form for physicians and nonphysician practitioners will go into effect May 1.


Expect HEDIS Records Requests From Third Parties - 02/28/2019

If a company called Ciox Health contacts your office on behalf of Blue Cross and Blue Shield of Texas or UnitedHealthcare, it is because both insurers have contracted with Ciox to collect performance data they are required by law to report.


Humana Changes for 2019: Preauthorization, Notification, and Formularies - 02/27/2019

Humana has made changes for 2019 to its preauthorization and notification lists.