Month: March 2021
Please Help POET Welcome:
POET email addresses: [email protected] and [email protected] have been disabled.
Information Blocking FAQs
THERE ARE NEW RULES
Regarding:
Information Blocking
Electronic Health Records
Patient Portals
Health Information Technology
To hear practical information from “Healthcare IT Today” on the coming “INFORMATION BLOCKING” regulation.
6 Keys to Addressing Denials
6 keys to addressing denials in your medical practice’s revenue cycle
MGMA STAT – MARCH 18, 2021
The Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders, “Has your organization seen denials increase in 2021?”
- 69% said “yes.”
- 31% said “no.”
Common responses from respondents included payers not reimbursing for codes related to COVID-19 supplies, critical care claims and imaging CTs.
For those healthcare leaders who reported an increase in denials, the average increase in denials was 17%.
- Half responded that they increased by 1% to 10%.
- 34% said 11% to 20%.
- 12% who stated 21% to 30%.
The poll was conducted March 16, 2021, with 576 applicable responses.
For great tips and strategies to use, follow this link or visit “The Business End” folder located in the InK files.
MGMA Community
This question was posed on the MGMA Community, March 2021.
Question: Posed from Community Member in Clearwater FL.
Would like to know how your offices are notating the total time on the date of patient visit for 99202-99215 OVs? Currently there is no statement from CMS re how the time must be documented other than total time is to be noted. We anticipate denials due to a lack of notation of time–is anyone seeing denials associated with this?
Reply #1: Community Member from Anchorage AK
Our provider’s note has the following statement at the end of each note:
I spent a total of 25 minutes on this appointment, including review of results, histories, x-rays, examination, consultation with the patient, and coordination of care.For office injections (which cannot be included in the total above if the patient came in for an office visit and the decision was made to also do an injection) we have this statement at the end of the procedure note:
I spent a total of 10 minutes prepping and performing the aspiration today, exclusive of and separate from the time spent on today’s appointment.
Reply #2: Community Member from New Jersey
We recommend to our clients that total minutes can be given, but giving the actual start & stop time is better. ” Pt. was seen for… from 9:01 – 9:22 for a total of 21 minutes.” Too many providers have total minutes that exceed 10-12-15 hours which is easy for auditors to see. That will keep providers out of trouble.
Aetna Commercial Drug Changes
Changes to Aetna's Commercial Drug Lists
On July 1, 2021, Aetna will update their pharmacy drug lists.
You’ll be able to view the changes as early as May 1, 2021. They’ll be available on our Formularies & Pharmacy Clinical Policy Bulletins page.
Ways to request a drug prior authorization
- Submit your completed request form through our provider portal on Availity
- For requests for nonspecialty drugs on Aetna Funding Advant age5M , Premier, Premier Plus, Small Group ACA and Value Plus plans, call the Precertification Unit at 1-855-240-0535 (TTY: 711). Or fax your completed prior authorization request form to 1-877-269-9916.
- For requests for nonspecialty drugs on the Advanced Control, Advanced Control – Aetna, Standard Opt Out, Standard Opt Out – Aetna, Standard Opt Out with ACSF, Aetna Health Exchange and High Value formulary plans, call the Precertification Unit at 1-800-294-5979 (TTY: 711). Or fax your completed prior authorization request form to 1-888-836-0730.
- For requests for drugs on the Aetna Specialty Drug List, call the Precertification Unit at 1-866-814- 5506 (TTY: 711). Or fax your completed prior authorization request form to 1-866-249-6155.
These changes will affect all drug lists, precertification, quantity limits and step-therapy programs. For more information, call the Provider Help Line at 1-800-238-6279 (TTY: 711) (1-800-AETNA RX).
Aetna Authorization Changes
Changes to Aetna National Precertification List (NPL)
As published in the March 1, 2021, edition of Aetna Officelink Updates™
As of July 1, 2021, these precertification changes apply:
- We’ll require precertification for:
- Cataract surgery
- Sacroiliac joint fusion surgery
- Knee arthroscopy with meniscectomy
- Vertebral corpectomy procedures
- Additional lower limb prosthetic codes including select foot, ankle and vacuum pump components
- Spinraza® (nusinersen) – precertification required for both the drug and site of care.
Submitting requests
Be sure to submit authorization requests at least two weeks in advance.
To save time, you can make your request online. Doing so is fast, secure and simple. You can submit most requests online through our provider portal on Availity. Or you can use the Electronic Medical Record (EMR) system portal.
Are you asking for drug prior authorization on a specialty drug for a commercial or Medicare member? Then submit your request through Novologix®, also available on Availity®.
Not registered for Availity?
Register online or call 1-800-AVAILITY (1-800-282-4548). For one-on-one support from us, call Aetna at 1-866-752-7021. Then ask to talk with the Availity team.
You can use our “Search by CPT code” search function on our Precertification Lists web page to find out if the code needs precertification.
You can learn more about precertification under the General Information section of the NPL.
UHC Cuts NPP Payments
A recent UnitedHealthcare (UHC) policy will not only cut payments by 15% to physicians who employ nonphysician providers (NPPs), but also cause needless confusion in the billing process.
That’s according to a letter the Texas Medical Association wrote to the insurer expressing concern over the policy, which took effect March 1.
UHC in December announced a policy that requires advanced practice nurses and physician assistants to bill for their services using their own National Provider Identifier (NPI) when they have not met “incident-to” billing requirements.
Payments billed using an NPP’s NPI number are typically 85% of the physician’s rate.
Despite medicine’s concerns, UHC further revised its policy in March to require that services provided by NPPs will be eligible for incident-to consideration – and thus the full 100% payment – only if the NPPs do not have their own NPI number.
That policy is scheduled to take effect May 1.
“It is TMA’s policy on physician assistants and allied health personnel that reimbursement for services performed by a physician assistant should be made directly to the responsible physician,” TMA wrote in a letter in February. “While greater use of nonphysician personnel can improve the system, responsibility for care must be clearly defined if various personnel are to work together effectively to provide high quality services for the patient.”
TMA also urged UHC to provide further education to physicians and NPPs on proper incident-to billing.
“As part of this effort, UHC should make it clear that physicians can continue to utilize advanced practice nurses and physician assistants under proper incident-to billing arrangements, even if the advanced practice nurse or physician assistant has their own NPI,” the letter says.
TMA is setting up a meeting with UHC officials to discuss the policy, and will report on any updates in Texas Medicine Today.
For more information on incident-to billing requirements, TMA has published a questions and answers document and billing guidelines.
Regarding the Ever Changing Telemedicine Guidelines.
KZA Telehealth Solutions Center
An up-to-date, comprehensive resource regarding
the ever-changing telemedicine guidelines.
KarenZupko and Associates, Inc. has been around for a long time.
They have shared a link to their website for updates to telehealth on the MGMA Community.
Please note, they update materials as changes are made by CMS.
So check back often!
There is a very nice chart on Payor Telehealth Policies and
lots more.
CoVid-19 Recovery Center:
Vaccine Billing and Coding Reference, MGMA 2021
For a listing of Vaccine names and their CPT Code, please follow this link to files on InK.
Reimbursement Policy Update Bulletin: UHC March 2021
UHC releases revised reimbursement policies for: Outpatient Hospital, Laboratory Services and Emergency Department E/M.
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