Business – Page 25

UnitedHealthCare Network News

Effective Feb. 4, 2022, UHC will no longer print and mail paper provider remittance advice (PRAs) for medical claims to network health care professionals.

UHC has updated their codes for the Outpatient Procedure Grouper (OPG) mapping. They have deleted 30 old codes and added 31 new codes. For more information follow this link.

Cigna Continues CoVid Accommodations

Over-the-counter testing

Consistent with new federal guidelines for private insurers, Cigna commercial will cover up to eight over-the-counter (OTC) diagnostic COVID-19 tests per month (per enrolled individual) with no out-of-pocket costs for the tests. This coverage began January 15, 2022 and continues through the end of the PHE (currently through April 15, 2022).

Please note that while Cigna Medicare Advantage plans do fully cover the costs for COVID-19 tests performed in a clinical setting, costs of at-home COVID-19 tests are not a covered benefit at this time.

Additionally, we encourage you to remind your patients that the Federal Government is now offering four free at-home test kits per household with no cost. Your patients can order the free at-home COVID-19 testing kits at COVIDtests.gov.

Coverage of COVID-19 treatments

As a reminder, Cigna commercial and Cigna Medicare Advantage cover FDA emergency use authorized (EUA) treatments of COVID-19, including monoclonal antibody treatments. This includes new antiviral medications Paxlovid^TM and molnupiravir, as well as Remdesivir infusions when administered in an inpatient or outpatient setting.

Get all the most up-to-date information

We updated our dedicated COVID-19 provider web page on January 21, 2022 to highlight these updates more. You can also access the latest Cigna Medicare Advantage billing guidelines from this page. Please visit the site often to get the latest information.

Tools to Determine If Vaccine Mandate Applies, from MLN Connects.

CMS.gov releases “CoVid-19: Tools to Determine if the Vaccine Requirements Apply to you.

Regarding New Telehealth Code

NOT ALL HEALTH PLANS ARE RECOGNIZING THE NEW TELEHEALTH CODE

TMA staff recommend you check with health plans directly to find out if they recognize the following:

POS 10, a new Centers for Medicare & Medicaid Services code that corresponds to telehealth provided to patients at home, set to take effect on April 4.
Modifier 93, an American Medical Association CPT code modifier now in effect that corresponds with a real-time medical service delivered by telephone or another audio-only technology.

Also not yet recognized by all health plans are the following Healthcare Common Procedure Coding System modifiers:

Modifier FQ (furnished using audio-only communication technology);
Modifier FR (supervising practitioner was present through two-way communication technology with both audio and video); and
Modifier FT (unrelated evaluation and management during a postoperative period, or on the same day as a procedure or another evaluation and management visit).

TMA reimbursement specialists are keeping watch on insurers’ recognition of codes and modifiers. TMA’s Health Plan News page will post new developments as they emerge; for example, as noted on the Health Plan News page, Humana is recognizing modifier FQ.

Continue to read Texas Medicine Today for updates.

Last Updated On January 20, 2022

The First Quarter 2022 issue of Cigna Network News is now available

Check out these pages:

4. Preventive Care Services Policy Updates

5. Reimbursement Policy Updates

7. Precert Updates (click here to view the Master Precert List)

8. Webinar Schedule for staff training.

18. 2022 Cigna MA plan highlights (and card sample)

25. How to use Z Codes

34. How to contact Cigna

AMA Toolkit Dissects Federal Surprise Billing Law

Much of the federal government’s solution to resolve certain out-of-network billing disputes without balance billing or otherwise involving patients – known as the No Surprises Act – took effect at the start of 2022.

Among other pieces physicians must familiarize themselves with, the new federal law features an independent dispute resolution (IDR) process that was intended to let physicians and insurers both make their case for fair payment. Naturally, plenty of minutiae and arcana exists within the law, and a portion of the rules for the IDR process is under a legal challenge from the Texas Medical Association and others in organized medicine.

To help physician practices understand and navigate the new law, the American Medical Association has created a toolkit, Preparing for Implementation of the No Surprises Act. The 20-page toolkit includes information on:

Operational challenges physicians “will need to address immediately” to be compliant with the law’s new requirements, such as when uninsured and self-pay patients must receive a good-faith estimate of charges before they receive services;
What services and care fall under the rules of the No Surprises Act;
Timetables and requirements for the IDR process; and
When and how facilities and physician practices can obtain a patient’s consent to balance bill for out-of-network care at an in-network facility.

AMA says it will update the toolkit “as additional guidance is available” and will develop new resources on parts of the law not already included in the toolkit.

For additional information on the No Surprises Act, you can check out TMA’s list of resources on the law, which has both similarities and differences to Texas’ IDR law governing state-regulated health plans.

Meanwhile, TMA and others are still pushing to ensure the implementation of the law is fair for physicians seeking to get paid. In late October 2021, TMA filed suit to challenge what physicians and hospitals say is an unfair piece of the IDR process outlined in federal rules. Check future editions of Texas Medicine Today for updates on that lawsuit.

The PHE Has Been Extended

The Public Health Emergency (PHE) has been extended for the eight time.

The federal Department of Health and Human Services (HHS) has extended the COVID-19 public health emergency (PHE) for another 90 days, which means many payer flexibilities are likely to continue as well. HHS Secretary Xavier Becerra issued the extension on Jan. 14, two days before the PHE was set to expire. The new extension runs through April 16. It is the eighth extension of the PHE since HHS originally declared the emergency in late January 2020.

GOOD FAITH ESTIMATE

Effective 1/1/2022

Beginning January 1, 2022 if a patient is UNINSURED or pays their own medical bills (if you don’t submit a claim to a health plan) the Provider MUST provide the patient with an estimate of expected charges BEFORE they provide the item or service.

It’s called a Good Faith Estimate (GFE).

ICD-10 Adds Z Codes

Starting April 1, 2022

You will have new ICD-10-CM Z codes to report if you find the patient you are treating is partially vaccinated or unvaccinated for COVID-19.

The changes include:

New subcategory Z28.31 (Underimmunization for COVID-19 status), and under it, two new patient status codes:
- Z28.310 (Unvaccinated for COVID-19).
- Z28.311 (Partially vaccinated for COVID-19).
Z29.39 (Other underimmunization status).

MGMA Washington Connection

COVID-19 PHE ends January 16, 2022 if HHS Secretary does not renew.

MGMA successfully advocates for sunsetting of healthcare ETS

On Dec. 27, 2021, the Occupational Safety and Health Administration (OSHA) issued a statement on the status of its COVID-19 healthcare emergency temporary standard (ETS), confirming that it is withdrawing the ETS with the exception of the recordkeeping portions.

Last August, MGMA urged OSHA to not make this standard permanent, due to it disrupting ongoing efforts of medical groups to balance the needs of patients against the imperative to protect employees. Although OSHA is letting this ETS sunset, it expressed its intentions to revisit the issue of protecting healthcare workers from COVID-19 in the future by issuing another standard. MGMA will urge the Agency to solicit input from stakeholders, such as medical groups, when developing such a standard.

Updated member resources to navigate surprise billing
On Jan. 1, 2022, the No Surprises Act requirements prohibiting certain out-of-network balance billing and new uninsured (or self-pay) good faith estimate price transparency requirements took effect. Throughout 2021, the Biden Administration released several rules implementing these newly effective requirements. The Administration will continue to release additional rules throughout 2022 outlining the remaining patient protections that have not yet been implemented.
The MGMA Government Affairs team has updated member-exclusive resources to help group practices better understand the requirements in place. Check out the most up-to-date resources on the MGMA Surprise Billing landing page.

MIPS 2021 data submission window open
Clinicians can now submit and review data for the 2021 performance year for the Merit-based Incentive Payment System (MIPS). The data submission window closes on March 31, 2022 at 8 p.m. (ET). The Centers for Medicare and Medicaid Services provided several flexibilities for clinicians due to the COVID-19 public health emergency, including applying an automatic reweighting of performance scores for individual clinicians.
In other MIPS updates: on Jan 1. 2022, the 2022 payment adjustment, based on clinician 2020 MIPS performance scores took effect and will be applied to Part B covered services. Additionally, looking ahead to the 2022 performance year, clinicians can now review their preliminary MIPS eligibility by signing into the Quality Payment Program website.

Category: Business