For information on how to submit a preauthorization for frequently requested services/procedures for your patients with Humana follow the links below.
Category: Medicare
New Prior Authorization Ruling Applies to Some,
But Not All.
In December 2022, I reported on a proposed rule from the Centers for Medicare & Medicaid Services (CMS) about updating requirements for prior authorization (PA), a process that many providers and patients consider to be a roadblock to obtaining care. Now, CMS has published the Final Rule (020824) on this topic, which contains significant requirements for health plans to follow to improve the process.
The rule only applies to a set of Impacted Payers: Medicare Advantage (MA) organizations, state Medicaid and Children’s Health Insurance Program (CHIP) Fee-for-Service (FFS) programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan (QHP) issuers on the Federally Facilitated Exchanges (FFEs).
Legally, these are the plans for which CMS can set requirements. However, it is expected that many commercial plans will voluntarily adopt some of these provisions.
The rule also adopts a new measure for Merit-Based Incentive Payment System (MIPS)-eligible clinicians under the Promoting Interoperability performance category of MIPS, as well as for eligible hospitals and critical access hospitals (CAHs), under the Medicare Promoting Interoperability Program.
For more information and detail, follow this link to the article written by Stanley Nachimson, MS
Receive More Accurate Payment for Medicare Complex Visits.
The new code will take effect Jan. 1, 2024. The 2024 Medicare Physician Fee Schedule allows physicians to list G2211 in addition to codes used in-office or outpatient visits for new or established patients (i.e., 99202-99215). Physicians can also use it for telehealth visits.
Texas Medical Association continues to push for additional guidance as confusion over the code’s use persists.
Medicare Physician Fee Schedule: New CPT Codes for RSV Vaccine Administration
Please Read Carefully
If your patient doesn’t have Medicare Part D, Medicare will pay for vaccine administration.
but not the vaccine under Part B.
CMS retroactively added 2 new CPT codes for respiratory syncytial virus (RSV) vaccine administration to the Medicare Physician Fee Schedule effective for dates of service on and after October 6, 2023:
- 96380 – Short descriptor: Admn rsv monoc antb im cnsl
- 96381 – Short descriptor: Admn rsv monoc antb im njx
Your Medicare Administrative Contractor will adjust claims you bring to their attention.
CMS Extends Telehealth Flexibilities to Protect Physician Privacy.
Following staunch advocacy by the Texas Medical Association, the Centers for Medicare & Medicaid Services (CMS) will not require physicians to list their home address as a practice location on Medicare enrollment forms for another year when providing telehealth services, safeguarding their privacy and safety.
During the COVID-19 pandemic, CMS allowed physicians to offer telehealth services from their homes without reporting their home address on their Medicare enrollment. However, that flexibility was set to expire Dec. 31.
Cigna MA Provider Directory
Per Jim there is an issue with the Cigna MA provider directory. Some providers are not listed. The problem has been reported and is being worked on. Thank you.
MLN Connects News
2024 Medicare Part B Deductible.
The annual deductible for all Medicare Part B beneficiaries will be $240 in 2024, an increase of $14 from the annual deductible of $226 in 2023.
Discarded Drugs and Biologicals:
When to Use JW and JZ Modifiers.
Read updated JW and JZ Modifier FAQs for additional clarity on billing with these modifiers (see FAQs 7, 8, and 18–22). CMS posted a new list of billing and payment codes only used for single-dose containers that may require the modifiers, depending on the setting:
Medicare Advantage Audits
In response, the Texas Medical Association has developed free CME to help member physicians prepare for such audits.
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