Month: July 2024
Humana Physician News Q2 2024 Newsletter
NEW! 2024 preauthorization lists (PAL) and notification requirements Lists of services and medications, effective July 1, 2024, that may require preauthorization for patients with Medicare Advantage, Medicaid, dual Medicare-Medicaid and commercial coverage are now available.
NEW! 2024 provider manuals Humana Medicare and Medicaid provider manuals, effective March 15, 2024, are now available.*
Quality and Stars learning series Humana provides educational webinars each month, covering Quality and Stars-related topics for both learning purposes and continuing education credits.
Good News, Bad News in Medicare 2025
A first look at the 2025 Physician Fee Schedule
The 2025 Physician Fee Schedule proposed rule is a study in contrasts. If you’re the kind of person who can see both sides of an issue, this rule is for you.
Good News
Bad News
Practitioners doing telehealth from their home can continue to use the practice address instead of their home address on claims for 2025
Without an act of Congress, for real time audio/visual visits on 1/1/2025 patients can no longer receive these services in their homes in all geographic areas. Patients must be in an underserved area and go to a facility setting for telehealth. (Unless Congress changes this in their end of year Consolidated Appropriations Act.)
16 new telehealth codes that can be selected based on Medical Decision Making (MDM) or time.
Medicare has given them a status indicator of invalid.
New HCPCS code for GIDXX for visit complexity inherent to in patient and observation services associated with a confirmed or inspected infectious disease. (GIDXX is a placeholder code, not a final code.)
Limiting use. “We anticipate the HCPCS code GIDXX would be reported by physicians with special infectious disease training”
Can use G2211 when you use modifier 25 for an E/M and wellness visit on the same day, immunizations, and other preventive medicine services.
That’s the only exception.
Need Help Meeting all the Components of the Compliance Attestation. Here is Help.
Ever thought about how a confident, well-trained front office team could transform your healthcare practice?
MGMA is thrilled to present the best front-office training in practice management, designed to improve patient interactions and boost your team’s performance. Make this a priority in your onboarding process today!
Make it a Priority.
Ed Plus is the easy-button on staff training, and it’s extremely cost-effective. Courses include:
- It All Starts Here: Front Office Mastery
- An Overview of Culturally Competent Care
- Controlling Healthcare Workplace Violence
- Dealing With Disruptive Patients
- Diversity, Equity, and Inclusion in the Healthcare Workplace
- Employment Law for Medical Practices
- Establishing and Maintaining a Healthcare Compliance Program
- Healthcare Fraud, Waste, and Abuse
- HIPAA Essentials for Medical Practices
- Keeping Up With Revenue Cycle Compliance
- Lean Leadership
- OSHA Bloodborne Pathogens Standard
- OSHA for Medical Practices
- Revenue Cycle Compliance and Fraud
- Safety First: Keeping Your Workplace Safe
- Sexual Harassment in the Workplace
Front Office Training Exclusively in Ed Plus, Follow this Link for more information.
Digital Precertification on CignaforHCP.com
- Beginning July 18, 2024, registered users with the Precertification – View and Submit entitlement have access to digital precertification correspondence via the Messaging Center on CignaforHCP.com.
- Digital correspondence notifies users when precertification letters are available, or when action is required to continue processing.
- Designate the following communication preferences by logging into CignaforHCP.com > Settings and Preferences > Communication Settings:
- The type of correspondence you want to receive (e.g., emails and/or alerts) when digital correspondence is available.
- Email notifications and frequency to alert you when new digital correspondence is available.
UHC Major Data Breach
Just four months after the Change Cyberhack, UnitedHealth Care is hit again.
Community Health Centers (CHC), has disclosed a major data breach. CHC has revealed that a “substantial quantity of data” was stolen, impacting a “substantial proportion of people in America.” UnitedHealth’s CEO Andrew Witty estimated one-third of all Americans have been affected by the breach. That is over 111 million people.
“While CHC cannot confirm exactly what data has been affected for each impacted individual, information involved may have included contact information (such as first and last name, address, date of birth, phone number and email.
This means that millions of individuals could be at risk of identity theft and other forms of fraud.
Don’t Tell My Insurance Company
“you can also ask your health care provider or pharmacy not to tell your health insurance company about care you receive or drugs you take, if you pay for the care or drugs in full and the provider or pharmacy does not need to get paid by your insurance company.”
If you would like to read this flyer or print it for your patients:
Cigna Denies Claims without Z-Code
Starting July 14th
Cigna Healthcare will deny certain claims that are billed with a Z-code and without documentation. A move that could add to your administrative burden.
Cigna will deny claims when practices bill certain evaluation and management (E/M) codes (99202-99215) with a preventive service code and a supporting Z diagnosis code – but not supplemental medical record documentation.
Physicians will need to refer to multiple policies by the payer to utilize both preventive services and problem-oriented E/M services for new and established patients on the same date of service, which Texas Medical Association billing and code experts caution could add to practices’ workload. Moreover, these services will not be payable by Cigna when billed with a Z diagnosis code alone.
TMA experts recommend including supporting medical record documentation with the diagnosis code for the problem E/M claim to identify why a preventive service – like dietary counseling, for example – was performed.
Physicians can also check Cigna’s preventive services policy for examples of Z codes or refer to Cigna’s E/M Reimbursement Policy for more payment information from the payer.
UHC Network News July 1, 2024
Take Note: Quarterly CPT and HCPCS Code Updates
Effective Jul. 1, 2024, all applicable Medical Policies and Medical Benefit Drug Policies have been updated to reflect the quarterly Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) code additions, revisions, and deletions. Refer to the following sources for information on the code updates:
FBI and HHS release Joint Cybersecurity Advisory
The Federal Bureau of Investigation (FBI) and the U.S. Department of Health and Human Services (HHS) have issued a joint cybersecurity advisory (CSA) to share known indicators of compromise (IOCs) and tactics, techniques, and procedures (TTPs) associated with a social engineering campaign. The campaign focuses on healthcare, public health entities, and providers, recognizing healthcare organizations as prime targets for hackers due to their large scale, reliance on technology, access to personal health information, and the significant consequences of disruptions in patient care.. ~Ann Ribeiro, Industrial Cyber News Editor
Recent Comments