Stories written by Ellen Terry

UnitedHealthcare Waives Cost Sharing, Extends Telemedicine for Certain Plans - 06/16/2021

UnitedHealthcare is waiving cost sharing for Medicare Advantage plan members for primary care services, and has extended access to in-network and out-of-network telemedicine visits, including COVID-19 testing and treatment, until Dec. 31 for most of its plans.

Some Payers Resume Prior Authorization Requirements - 04/14/2021

Several commercial payers have resumed prior authorization time frames and requirements that had been suspended because of the COVID-19 emergency, while others will continue to approve prior auth requests or suspend them for at least part of the year.

Revised UnitedHealthcare E&M, Prior Auth Procedures to Take Effect Jan. 1 - 12/09/2020

The Texas Medical Association’s reimbursement specialists want to be sure you see the following items in the UnitedHealthcare (UHC) December bulletin.

Blue Cross Bundles Payment for Some Diagnostic Services - 11/16/2020

Effective July 1, Blue Cross and Blue Shield of Texas will cut payments for certain diagnostic procedures. The cut will apply to diagnostic cardiovascular and ophthalmology procedures that are billed for the same patient on the same day.

Cigna Extends COVID-19 Waivers - 11/10/2020

With the COVID-19 public health emergency now set to end Jan. 20, Cigna has extended some of its waivers and other COVID-19 exceptions, and introduced some payment changes.

See Blue Cross Referral Chart, Colonoscopy Coding Tips - 10/14/2020

As a result of “feedback from the provider community,” Blue Cross and Blue Shield of Texas has removed 111 procedure codes from its preauthorization requirements related to additional care categories of codes.

Upgraded Free Tool Helps With HIPAA Compliance - 10/12/2020

If you participate in the Medicare Merit-Based Incentive Payment System (MIPS), you must complete your security risk assessment by Dec. 31. An upgraded tool from the U.S. Department of Health and Human Services might make the assessment easier.

How Health Plans Are Covering COVID-19 Testing and Treatment - 10/09/2020

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.

Blue Cross Prior Authorization Manager Changing - 09/30/2020

Starting Jan. 1, AIM Specialty Health will manage certain outpatient prior authorizations for some Blue Cross and Blue Shield of Texas (BCBSTX) patients.

Charging Concierge Fees to BCBSTX Patients - 09/23/2020

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.

Ambetter: New Required Field on CMS-1500 Claim Form - 09/23/2020

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.

UnitedHealthcare Phasing Out Paper Checks - 08/03/2020

If you receive claims payments from UnitedHealthcare (UHC) in paper checks, now is the time to enroll in direct deposit. UHC says it will phase out sending paper checks for payments throughout the remainder of 2020

Telemedicine Payments Promised, Regulations Eased - 07/30/2020

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.

New CPT Code Is “Industry Standard” for COVID-19 Antigen Testing - 07/08/2020

Three new Current Procedural Terminology (CPT) codes are now on the list of COVID-19 lab testing codes, effective June 25

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.

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.

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.