Category: Business
HOSPITALS ARE REQUIRED!!
As of May 1, hospitals are now REQUIRED to electronically share their admit, discharge, and/or transfer (ADT) notices with the patient’s established primary care physician (pcp), group, or other practitioner identified by the patient.
As part of the same rule, PHYSICIANS ARE REQUIRED to update their digital contact information in the National Plan and Provider Enumeration System so hospitals have the information they need to electronically send the ADT notices.
UHC Waives Cost Sharing
UnitedHealthcare (UHC) is waiving cost sharing for Medicare Advantage plan members for primary care services through Dec. 31. This applies to in-network and covered out-of-network COVID-19 and non-COVID-19 visits, whether they are conducted in office or via telemedicine.
Provider Roster Update
Who’s On First?
Or should we say “Who’s in What”
This roster includes all the POET physicians and list what insurance plans they have opt’ed into.
It is a great tool to keep at your front desk or download for the person who makes the referrals in your office.
Oh, just google “Who’s on first” and watch the clip, for a little slap stick humor.
From CMS.Gov
Critical Care Evaluation & Management Services: Comparative Billing Report in May
In late May, CMS will issue a second letter in the Special Edition Comparative Billing Report (CBR) series on Part B claims for critical care evaluation & management services. Use the data-driven tables to compare your billing and payment patterns with peers in your state and across the nation.
The public can’t view CBRs. Look for an email from [email protected] to access your report. Update your email address in the Provider Enrollment, Chain, and Ownership System to ensure delivery.
More Information:
- View a webinar recording
- Visit the CBR website
- Register for a live webinar on June 9 from 3-4 pm ET
Protecting Workers:
Guidance on Mitigating and Preventing the Spread of COVID-19 in the Workplace
The Centers for Disease Control and Prevention (CDC) has issued new guidance relating to recommended precautions for people who are fully vaccinated, which is applicable to activities outside of healthcare and a few other environments. OSHA is reviewing the recent CDC guidance and will update our materials on this website accordingly. Until those updates are complete, please refer to the CDC guidance for information on measures appropriate to protect fully vaccinated workers.
Updated Plan Reps
The Health Plan Representative Contact List has been updated.
Need Expert Advice
The Texas Medical Association is launching a new “Ask the Expert” virtual series to bring members direct access to professional experts who can answer questions on legal, practice management, advocacy, and regulatory topics.
Join them each month as a TMA staff expert hosts a virtual meeting to discuss their area of expertise and answer questions from attendees
BCBS UPDATE 5/12/2021
SA Modifier and Midlevel Provider Contracting Update.
On January 19, 2021, Blue Cross and Blue Shield of Texas (BCBSTX) posted an article regarding contracting and credentialing midlevel providers and the upcoming implementation of the ClaimsXtenTM edit of the SA modifier for non-payable services resulting in the SA modifier being non-reimbursable. This edit has not been implemented and there are currently no plans for future implementation of this edit.
SA Modifier Reminder
The SA modifier should be used:
- By the supervising physician, when he/she is billing for services rendered by a Physician Assistant (PA), Advanced Practice Nurse (APN), Certified Registered Nurse First Assistant (CRNFA) or Licensed Surgical Assistant (LSA).
- On claims submissions by PA or APN’s when billing under their own NPI number for assisting with any other non-surgical procedures.
This information can be found in the Clinical Payment and Coding Policies – Modifier Reference Guideline located on the provider website. Information about the reimbursement amount for the SA modifier is available in the Reimbursement Schedules and Related Information (Secure Content) area of the General Reimbursement information page. You will need a password to access this information which can be obtained from your local Network Management Office location.
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