Medicare – Page 7

Your Patient’s MBI may change!

Over 47,000 Medicare Beneficiaries may been involved in a Data Breach that involved Personally Identifiable Information (PII) and/or Protected Health Information (PHI).

New Medicare Cards with a new Medicare Beneficiary Identifier (MBI) are being mailed out.

Ask Your Patients, If They Have A New Medicare Insurance Card!!

Renewed Form for ABN

The ABN, Form CMS-R-131, and form instructions have been approved by the Office of Management and Budget (OMB) for renewal. The use of the renewed form with the expiration date of 01/31/2026 will be MANDATORY on 6/30/23.

The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, is issued by providers to Original Medicare (fee for service – FFS) beneficiaries in situations where Medicare payment is expected to be denied.

The ABN is issued in order to transfer potential financial liability to the Medicare beneficiary in certain instances

CMS Efforts to Reduce Prior Auth Burden

Insurers must halve the length of time they take to respond to prior authorization requests

Insurers may no longer require preapproval for emergency behavioral healthcare.

Insurers have to explain denials and publish data on their decisions.

Patients in active treatment who change carriers must be given at least 90 days before the new insurer can require another prior authorization.

Click the below articles for more information.

Cigna CoVid Coverage Changes

Changes in coverage effective May 12, 2023

The White House has announced their intent to end both the CoVid-19 National Emergency and Public Health Emergency (PHE) on May 11, 2023.

As a result, Cigna Commercial and Cigna Medicare Advantage plan to make the following changes on May 12, 2023:

Authorizations for facility-to-facility transfers will again be required.
Patient cost-share will apply to COVID-19 lab tests as well as antiviral and therapeutics approved by the U.S Food & Drug Administration (FDA).
For most benefit plans, COVID-19 vaccines will be covered at 100 percent under the preventive benefit (same as the flu shot) when customers go to an in-network provider.
Over-the-counter COVID-19 tests will no longer be covered.

UHC April Monthly Overview

For Texas:

Starting June 1, 2023, Optum will manage prior authorization and step therapy requests for prescription medications for Texas residents with pharmacy coverage.

Medicare vs Inflation

As part of a broader push for Medicare payment reform, the Texas Medical Association, along with the American Medical Association and 133 national specialty and state medical associations, recently called on Congress to index Medicare physician payments to inflation.

POET Says Farewell

As of March 31st, Leslie Anders is no longer with Cigna MA.

Please direct Cigna MA issues and questions to:

Jim Denman

(936) 635-0612

[email protected]

Please be patient, Jim will be filling both positions until Cigna finds a replacement.

Medicare Patient Additional Support

Have You Identified Patients That Need Additional Support?

Physicians may refer Cigna Medicare patients to Cigna’s multiple Care Management (Patient Support) programs. Simply by sending an email to the Care Management team at [email protected]

To request an eligibility assessment review for your patient or learn more, contact Cigna Medicare Advantage patient support programs:

email: [email protected]

Include:

Provider Name and Phone #
Patient Name
Patient Healthplan ID #
Any additional information we may need relevant to medical, pharmaceutical, behavioral, or SDOH needs

Remember to use secured email when sending patient PHI or diagnostic information in order to protect patient information.

Prevent Improper Code Bundling

Physicians can take advantage of a new Medicare tool to sort through service codes that can be bundled together for claims payment – and AVOID improper billing.

The CMS recently released the National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) lookup tool to promote accurate code-bundling and prevent improper payment of Medicare Part B and Medicaid claims when incorrect code combinations are reported.

Available via Texas’ Medicare contractor Novitas Solutions, the tool is further designed to help physicians identify when certain pairs of codes are subject to automated edits.

AND FOR EVEN MORE TOOLS

CLICK ON ANY OF THE BUTTONS BELOW

UHC Reconsideration and Appeals Going Digital

This change affects Commercial and MA health care professionals.

Category: Medicare