NOV
19
EmblemHealth to Provide Medicare Advantage Benefits to Former Affinity Members
Beginning January 01, 2019, EmblemHealth will provide Medicare Advantage benefits to approximately 10,000 members who were previously in Affinity's Medicare Advantage plan....
OCT
17
Order Requirements When Prescribing Practitioner is Also the
Supplier and is Permitted to Furnish Specific Items of DMEPOS
Background: This clarifies CMS requirements for a written order when the prescribing
practitioner is also the supplier, and is permitted to furnish specific items of DMEPOS...
CMS Correcting Errors in
2017 MIPS Final Score
CMS has extended its targeted review process to October 15 to allow eligible clinicians,
groups, and those participating in certain alternative payment models (APMs) to carefully
look over their 2017 Merit-Based Incentive Payment System (MIPS) final score...
OCT
3
Reminder for Your Patients in UnitedHealthcare Oxford Commercial Plans
If you have patients who employers are renewing their health coverage with a United-Healthcare Oxford commercial plan, you’ll see some differences in their new member identification (ID) card thar we want to remind you about...
AUG
28
Emblem Health-GHI Plans-Modifier 25 with Evaluation and Management Services Reported with Procedures
Modifier 25 is used to define a substantial, separately identifiable evaluation and management (E/M) service that was performed at the same time as a procedure...
Medicare Claims Processing Manual
Update
Medicare is prohibited from paying claims submitted in a non-electronic manner
that do not meet the limited exception criteria. The issuance of waivers under this limited exception criteria to is discussed in Chapter 24, Section 90 of the Medicare Claims Processing Manual....
JUL
26
Medicare Will Likely Face Pushback on Physician Pay Changes
Federal officials will likely encounter some resistance to a proposed overhaul of
Medicare's payment for evaluation and management (E/M) services, which could
raise this reimbursement for some specialties while lowering it for others...
News Alerts
This section provides the latest and essential industry updates as they become available.
DEC
4
2019 MIMEDX Code Update
The following changes will go into effect January 01, 2019:
UnitedHealthcare-Oxford Participating Surgeons Using
Non-Participating Assistant Surgeons and Co-Surgeons
Effective Jan 1, 2019, UHC network physician and other qualified health care professionals in Connecticut and New York will be required to use network care providers for assistant surgeon and co-surgeon services for UHC Oxford members unless...
Update and Reminder for Medicaid Provider Billing-Documentation Required for Medicare and Third-Party Insurance Primary Submissions
All crossover claims submitted from Medicare and other third-party billing should accurately reflect payments received from other insurers to allow correct calculation of Medicaid reimbursement amounts...
Non-Physician Practitioner E/M Claims: Change in Submission Instructions Effective 09/15/2018
In response to CMS’s current initiative to reduce provider burden in the Medicare claim process,
National Government Services (NGS) is pleased to announce a significant change in submission and processing steps...
UnitedHealthcare-Medical Record Review-ACA-Covered Commercial Plans for 2018 Dates of Service
UHC is required by the Department of Health & Human Services (HHS), under the Affordable Care Act (ACA), to submit complete diagnostic information about members enrolled in certain Commercial ACA-covered health plans...
OCT
11
CMS Announces 2019 Medicare
Parts A&B Premiums and Deductibles
Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment,
and certain other medical and health services not covered by Medicare Part A...
OCT
1
Prior Authorization for Select Foot
Surgery-UnitedHealthcare Commercial
Effective Jan 01, 2019, All Savers members on
policies 908867 and 908868 and Oxford Individual members on policy 908410 will require prior authorization for select ...
eviCore Restrictions on Diagnostic Services Performed on 1199SEUI Member
Providers are submitting claims for diagnostic services to 1199 and receiving denials that state "we do not pay podiatrists for this service", even after calling 1199 prior to the exam and being informed that no precert was necessary...
AUG
14
Duplicate Claim Submission Reminder
National Government Services has an important reminder regarding duplicate
claim submissions. Services that have been processed for payment or denial
should not be refiled as a new claim to correct submissions errors...
Implementation of Automating First Claim Review in Serial
Claims for Durable Medical Equipment, Prosthetics, Orthotics
and Supplies (DMEPOS)
CMS considers serial claims to be claims that are so closely related to one another that the same payment decision should be applied to each claim. In general, serial claims are for...
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