Stories written by Ellen Terry

Telemedicine Payments Promised, Regulations Eased - 06/29/2020

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 - 06/29/2020

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?


Payers Extend Claims Filing Deadlines - 06/25/2020

Some health plans have relaxed their timely claims filing limits as part of their COVID-19 policies. Payers have adopted various temporary deadlines and extensions, so be sure you file within each payer’s timeline if you choose to delay filing claims.


How Health Plans Are Covering COVID-19 Testing and Treatment - 06/24/2020

Many health insurers in Texas are waiving patient costs associated with COVID-19. Last week in a news release, Gov. Greg Abbott and the Texas Department of Insurance asked insurers and HMOs to cover testing consistent with Centers for Disease Control and Prevention guidance, and telemedicine visits.


Invoice No Longer Required for Some Medicare Claims - 06/03/2020

For certain biologicals and medications reported in Medicare Part B claims, Novitas Solutions now will allow you to enter invoice information on the claim, rather than provide the actual invoice for the services.


Use “Time, MDM” for Medicare Telehealth Coding - 06/02/2020

When coding for Medicare telehealth visits, you can use either medical decisionmaking (MDM) or time as the basis for your selection of office/outpatient evaluation and management (E&M) levels of service, the Centers for Medicare & Medicaid Services has clarified.


Payers Extend Prior Authorization Windows During COVID-19 - 05/19/2020

Commercial payers have temporarily modified prior authorization timelines to help physicians care for patients during the COVID-19 emergency. Here is an overview of some payers’ COVID-19 prior authorization policies.


Never, Ever Text Patient Hospital Orders - 05/12/2020

No matter how comfortable you are with texting, remember, texting patients’ hospital orders is not an acceptable practice.


Payers Ease Credentialing During COVID-19 - 05/05/2020

Commercial and government payers have temporarily eased credentialing requirements and procedures so more physicians can care for patients during the COVID-19 emergency.


Are You Ready for Telemedicine Prime Time? - 04/22/2020

Like a stage actor who comes across awkward on a television or movie screen, you might find it challenging to connect with your patients during video telehealth visits. Here are some tips to make for five-star video telehealth visit.


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.