Category: Business
UHC November Monthly Overview
Texas Medicaid: Earn 5.5 hours of free CE
UnitedHealthcare Community Plan of Texas and the American College of Lifestyle Medicine (ACLM) are partnering to offer 5.5 hours of free CE
Keep Your Staff Up to Date
Feel Free to Download and Print.
These lists can help your staff in so many ways.
Just Click, Download and Print
Cigna Digital Solutions Update 11/1/2023
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Beginning October 31, 2023, when you verify eligibility for patients with a third-party administrator (TPA) plan, the electronic data interchange (EDI) 271 transaction will indicate whether they are covered or not covered using information from Cigna Healthcare, as well as the TPA. It will also provide the TPA name and telephone number to confirm further eligibility or benefit information. What are TPA plans? How do I determine if my patient has a TPA plan? Patients with a TPA plan will have “Shared Administration” (or the letter “S”) at the bottom right of their TPA ID card (see the sample below). This designates that Cigna Healthcare shares the administration of the plan with a TPA. The ID card also includes the TPA phone number to call for eligibility and benefits information. |
STOP BACK OFFICE THEFT
5 Tips to Help Stop Theft in Your Back Office
It’s unfortunate, but even in today’s era of two-factor authentication and hyper-alert security, we still hear stories of physicians being defrauded by their employees. To help protect yourself from financial fraud, consider adopting these five approaches in your practice.
1) Cross-Train Your Employees
The most common place for fraud to occur is in the back office of small businesses where only one person handles the cash and books. Train more than one person on the cash conversion cycle. Rotate people through the various processes, too, so that no single person operates in a silo. When multiple people know the process, they can check each other’s work for mistakes and anomalies. Cross-training employees helps to create an open and transparent environment. It also reduces the chance of theft by assuring no one person wields too much power. Ultimately, it would be best if you also knew the process, so you can be an effective leader and fiscally responsible business owner
Aetna OfficeLink Updates, Oct. 1, 2023
Healthcare Common Procedure Coding System (HCPCS) modifiers FX and FY
Effective January 1, 2024, we will reduce payment for radiology procedures billed with modifiers FX and FY to align with the Centers for Medicare & Medicaid Services (CMS) guidelines.
• Modifier FX (X-ray taken using film): A 20% payment reduction applies to the technical component (and the technical component of the global fee).
• Modifier FY (computed radiography X-ray): A 10% payment reduction applies to the technical component (and the technical component of the global fee).
Reimbursement for code A9279
(monitoring feature/device)
Effective January 1, 2024, Aetna® will no longer reimburse for code A9279, since it is considered statutorily non-covered.
Cigna MA on CoVid Testing Coverage and Reimbursement.
The waiver for customer cost-share for physician visits for test (both in and out of network) ended May 11, 2023. However, laboratory tests for CoVid ordered by the provider will continue to be covered with no out-of-pocket costs following the end of the PHE on May 12, 2023.
Health Plan Representatives Updated
The Health Plan Representative list has been updated. Please give a copy to everyone that might need it in your office.
HCC Tip Card
Hierarchical Condition Categories (HCCs) aren’t a new concept, but as more and more organizations shift to value-based care, the lack of a foundational knowledge of HCCs, could result in lower rates of reimbursement, or sometimes not getting paid at all.
Hierarchical Condition Categories, are sets of medical codes that are linked to specific clinical diagnoses.
HCCs are used by CMS as part of a risk-adjustment model that identifies individuals with serious acute or chronic conditions. This allows Medicare to project the expected risk and future annual cost of care.
A RAF, (Risk Adjustment Factor) score is a measure of the estimated cost of an individual’s care based on their disease burden and demographic information. Each HCC associated with a patient is assigned a RAF that is averaged with any other HCC code factors and a demographic score. The resulting score is the payment amount a provider receives for a patient. Healthier patients will have a below average RAF while sicker patients will have a higher one, which impacts the calculated payment amount.
The below linked HCC Tip Card is a few years old, but maybe it can help us understand how HCC is weighted.
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