KR2 Medical Billing

I am proud to announce that an updated webinar: Fasenra-updated medical billing and coding guidance w/prior auth criteria 2020/2021 IS available on my Thinkiffic website. What you get (partial list): Learn new medical billing and coding guidelines-2020/2021 Major updates for MVP plans (NY)-2020/2021 Handle denial management with confidence! Get approved on your FIRST submission! All these benefits and more! Register today! Bonus includes full reimbursement /medical policies as well as prior authorization forms (for several various insurance payers). #Fasenra2020/2021changes, #Fasenra #fasenraautoinjector, #fasenrabuyandbill,#fasenraprioruath http://kr2billing.com//new-updated-on-demand-webinar-fase/

According UHC October Provider Updates- there are several new codes that are being added to the Radiology Prior Authorization List. This list applies to ALL plan types: Medicare Advantage, Community, and Commercial. The change will go into an effect for Dates of Service on 01/01/2021 and thereafter. Below is the list of new added codes: http://kr2billing.com//uhc-radiology-code-list-expanded-f/

Coding Guidance for Pharmacies New York Medicaid plans will reimburse Providers for COVID-19 specimen collection or CLIA waived COVID-19 testing for Medicaid Members, when such collection or testing is in compliance with the Governor’s Executive Order #202.24. * For Pharmacies- do not bill for Specimen Collection. Reimbursement includes the COVID-19 testing and specimen collection. Furthermore, if the Pharmacy is receiving payment from another insurance for COVID-19 testing or lab specimen collection, the Pharmacy SHOULD NOT bill NY MEDICAID. To see the full announcement please click here. http://kr2billing.com//ny-medicaid-reimbursement-for-covi/

Effective 07/01/2020- Medicare and Commercial: Effective for DOS 03/01/2020 and thereafter These codes should only be used when the provider or facility is NOT running the test. +Providers should bill 99211-CS for collecting specimen in the office setting. +Independent clinical diagnostic laboratories should bill G2023 or G2024 (for patients that are homebound, in skilled nursing facility) +Outpatient Hospitals should use C9803 to code for symptoms assessment and specimen collection. [ 167 more words ] http://kr2billing.com//emblemhealth-ny-updated-medical-bi/

According to MVP provider updates- MVP has lifted the restriction of max 8 visits per calendar year. As of 11/1/2020- there will be no maximum number of SCC or smoking cessation counseling. Instead, MVP will cover as many sessions as needed, based on medical necessity. Reminder that SCC services include: screening, behavioral interventions, medication for adults, and behavioral interventions for school-aged children and adolescents, as appropriate. [ 31 more words ] http://kr2billing.com//mvp-ny-smoking-cessation-counselin/

There are 3 new networks that will be available for Medicare members to choose from, for the year 2021. These plans are for group and individual members. Below are the description for these notworks: 1. VIP Prime Network- the largest network for group Medicare members. Medicare Plans on this network require the members to select a PCP and [ 82 more words ] http://kr2billing.com//emblemhealth-ny-medicare-new-netwo/

On 08/10/2020 Texas Medicaid & Healthcare Partnership (TMHP) made an announcement that: Effective for dates of service on or after April 1, 2020, procedure code S8301 for infection control supplies above and beyond normal protocol will become a benefit for Texas Medicaid. Procedure code S8301 may be reported for any encounter in which personal protective equipment (PPE) above and beyond normal protocol is required to safely treat a patient with or without a diagnosis of COVID-19. [ 241 more words ] http://kr2billing.com//texas-unitehealthcare-community-pl/

As of 09/08/20-there is a new CPT code 99072 became available for PPE. Definition 99072: Additional supplies, materials, and preparation time required and provided by the physician or other qualified health care professional and/or clinical staff over and above those usually included in an office visit or other service(s), when performed during a nationally declared public health emergency due to respiratory transmitted infectious disease. [ 243 more words ] http://kr2billing.com//ny-state-dfs-ppe-clause-patients-a/

As per September 2020 Aetna Provider Correspondence- Care Coordination is Reimbursable. In order to qualify for payment for care coordination, patient must have a behavior health diagnosis. Care coordination includes communication between the following: +Behavioral health providers, such as therapists and psychiatrists +Behavioral health and medical providers, such as psychiatrists and primary care physicians Although, care coordination is available to Aetna Members at no cost, there are exceptions: All Medicare plans and any high deductible health plan with a health savings account, until members meet the deductible. http://kr2billing.com//aetna-reminder-care-coordination-i/

What is AMP HEDIS Measure? 1. The percentage of patients 1 to 17 that had two or more antipsychotic prescriptions and had both of the following in the measurement year: +Had at least one test for blood glucose: blood glucose test, or HbA1c test + Had At least one cholesterol test, or LCL-C test Eligible population ages: 1 to 17 years of age as of December 31 of the measurement year. [ 87 more words ] http://kr2billing.com//amp-hedis-measure-metabolic-monito/

According to Aenta- starting in December 1, 2020. Aetna will require providers to request a prior authorization for non-emergent outpatient diagnostic left and right heart catheterization services. If prior authorization is denied or was not requested then ALL/ANY related angioplasty procedure will also be denied. Please visit eviCore for the complete list of procedures that require an approval. (link) How to request an authorization: [ 132 more words ] http://kr2billing.com//aetna-angioplasty-services-outpati/

According to their update published in August 2020, the following changes are going to take place. Effective 09/15/2020, Aetna Better Health of Louisiana will no longer use eviCore to process their prior authorizations for Pain Management. Instead the Authorization requests will be processed directly by the Aetna Better Health of Louisiana. Below is the partial list of those codes (except those with * or **) [ 135 more words ] http://kr2billing.com//aetna-better-health-of-louisiana-p/

According to UHC, in order to prevent payment issues for multiple skilled nursing visits on the same day, providers need to bill in the following manner: a. Bill each visit on its own line b. Bill each visit with its RVU and HCPCS/CPT codes c. The subsequent visits should be billed with a qualifying modifier (ex. XE) Adding the appropriate modifier will ensure that the additional visit will be identified and processed for payment correctly, at expected rate. For more information, please click here, for UHC Medicare Advantage Guidelines/Definitions. . http://kr2billing.com//billing-for-multiple-home-health-v/

This is a reminder for PT/OT providers that see EmblemHealth HIP (Health Insurance Plan of Greater NY), and HIPIC (Insurance Company of NY), and GHI EPO/PPO non-City of New York patients (added to the list) EmblemHealth partnered with Palladian Muscular Skeletal Health- a specialty network and utilization management company. Q1. What is Palladian is responsible for? A1. Palladian is responsible for the following functions: [ 115 more words ] http://kr2billing.com//emblemhealth-ny-physical-therapy-o/