Month: June 2023
How to Better Manage Incoming Calls
Seven easy ways to expedite the incoming phone call process.
1). Simplify, shorten, and reorder the greeting.
2). Reduce the number of rings before rolling to voice mail.
3). Tell patients when to expect action or a call back (this is crucial).
4). Equip staff to handle calls effectively.
5). Secure a portal for patient communication.
6). Provide patients with educational materials they can reference at their leisure.
7). Provide patients with a summary of the visit.
To gain a better understanding of root cause please read this short informative article from Physicians Practice. It can be a great revamping and or training tool.
Renewed Form for ABN
The ABN, Form CMS-R-131, and form instructions have been approved by the Office of Management and Budget (OMB) for renewal. The use of the renewed form with the expiration date of 01/31/2026 will be MANDATORY on 6/30/23.
The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, is issued by providers to Original Medicare (fee for service – FFS) beneficiaries in situations where Medicare payment is expected to be denied.
The ABN is issued in order to transfer potential financial liability to the Medicare beneficiary in certain instances
TMA Welcomed Unanimous Passage of House Bill 3359.
A major win for medicine in that it codifies the state’s network adequacy rules by putting them into statute and strengthens their enforcement by the Texas Department of Insurance (TDI).
“HB 3359 restricts insurers from making unilateral contract changes and tackles the problematic waiver process which leaves patients unprotected and in the dark.”
TMA now looks to the rulemaking process. TDI has indicated it likely will rewrite the state network adequacy rules impacted by HB 3359
Aetna Claim and Code Review Program
This update applies to Aetna’s Commercial, Medicare and Student Health members.
Beginning September 1, 2023, you may see new claim edits. These are part of our CCRP. These edits support our continuing effort to process claims accurately for our commercial, Medicare and Student Health members. You can view these edits on our Availity provider portal.*
For coding changes, go to Aetna Payer Space > Resources > Expanded Claim Edits
With the exception of Student Health, you’ll also have access to our code edit lookup tools. To find out if our new claim edits will apply to your claim, log in to the Availity provider portal. You’ll need to know your Aetna® provider ID number (PIN) to access our code edit lookup tools
Aetna on Pre-certs
Submitting Precertification Request
Be sure to submit precertification requests at least two weeks in advance. To save time, request precertification online. Doing so is fast, secure and simple.
You can submit most requests online through our Availity provider portal.* Or you can use your practice’s Electronic Medical Record (EMR) system if it’s set up for electronic precertification requests. Use our “Search by CPT® code” search function on our precertification lists page to find out if the code requires precertification.**
UHC June Monthly Overview
Policy and Protocol Updates
BCBS June 1, 2023 HCPCS Update
POET has had a number of request regarding the BCBS Quarterly HCPCs Update.
You may use Ctrl + F to search or download the entire document.
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