CoVID-19 Vaccine Mandate

This regulation will not apply to physician’s offices because they are not subject to CMS health and safety regulations.

Nov 4, 2021, the Biden administration released two rules pertaining to COVID-19 vaccine mandates. Both rules will require applicable employers and healthcare facilities to fully meet vaccination requirements by Jan. 4, 2022

MGMA

CoVid-19 news from UHC

Temporary cost share waivers extended; additional billing guidance issued

CPT code for Janssen CoVid-19 Booster

October 27, 2021

The new CPT code for the booster dose of the Janssen COVID-19 vaccine joins unique CPT codes previously issued to COVID-19 vaccine booster doses from Moderna and Pfizer. 

For quick reference, the new code assigned to the Janssen booster for the COVID-19 vaccine is:

0034A    Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5×1010 viral particles/0.5 mL dosage; booster dose

UHC Policy Updates November 2021

 Community Plan

 Reimbursement Policy Update Bulletin: November 2021

 Medicare Advantage

 Reimbursement Policy Update Bulletin: November 2021

 Commercial

 Medical Policy Update Bulletin: November 2021

 Community Plan

 Medical Policy Update Bulletin: November 2021

 Medicare Advantage

 Coverage Summary Update Bulletin: November 2021

UHC Link Down   at this time

 Medicare Advantage

 Policy Guideline Update Bulletin: November 2021

UHC Link Down   at this time

UHC November Policy Updates

Two New Files Added

Cigna Network News

PHE Extended, Again

Department of Health and Human Services (HHS) Secretary Xavier Becerra has once again renewed the public health emergency (PHE) for COVID-19, effective Oct. 18, 2021. The extension will continue all telehealth waivers and other flexibilities pursuant to the PHE determination for another 90 days. Unless it is further extended, the current determination will lapse on Jan. 16, 2022. As a reminder, the Biden administration has indicated that it intends to provide the healthcare community with 60 days’ notice prior to allowing the PHE to lapse.

More on the PHE

Attention: Codes deleted from ICD-10

ATTENTION!

Please Read!

Thirty-nine codes were deleted from the 2022 ICD-10 code set effective October 1, 2021.

Three of these 39 codes are billed by PCPs quite frequently:

M54.5 (low back pain)

R05 (cough)

R63.3 (feeding difficulties)

POET has been told, “Cigna Medicare is denying the whole claim as “inappropriate diagnosis code” when billed with one of these deleted codes. “

ICD-10

Texas Prepares to Inplement “GOLD CARD”

HAD YOUR FILL OF BURDENSOME PRIOR AUTHORIZATIONS?

For the Nitty Gritty of how House Bill 3459 is supposed to make your life easier follow this link to the TMA article by Joey Berlin.

TMA

Biden Vaccine Mandate Plan

Earlier this month, President Joe Biden introduced a six-point plan that mandates COVID-19 vaccines for millions of Americans.

Many details of the plan are still being developed as specific regulations are written, but at least one aspect of the plan is clear: The vaccination mandate for “over 17 million health care workers at Medicare and Medicaid-participating hospitals and other health care settings,” largely does not apply to small physician practices, according to Texas Medical Association analysis