Category: Medicare
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
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UHC Reconsideration and Appeals Going Digital
This change affects Commercial and MA health care professionals.
Cigna 1st Qtr 2023 Network News
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Is CIOX a Pain?
If you are having issues with CIOX, please let POET know.
UHC MA Plans
The below list is for Provider use only. Not to be distributed to Patients.
Information Provided by Melissa Boyd, UHC Network Account Manager
Cigna MA Plans for 2023
The below list is for Provider use only. Not to be distributed to Patients.
Know your “H” numbers.
HMO Customer Benefit Plans for Our Service Area
PPO Customer Benefit Plans for Our Service Area
Cigna Preferred Medicare HMO, H4513-061
Cigna True Choice Medicare PPO, H7849-038
Cigna Preferred Savings Medicare HMO, H4513-066
Cigna Tru Choice Medicare PPO, H7849-062
Cigna Courage Medicare HMO, H4513-009
Cigna TotalCare HMO D-SNP, H4513-060
Great News for Insulin Dependent Medicare Patients
In August 2022, the Inflation Reduction Act (IRA) was passed. Among other items it will lower prescription Drug Costs for Seniors.
The Inflation Reduction Act (IRA) will help close the gap in access to medication by improving prescription drug coverage and lowering drug prices in Medicare.
The Law:
- Caps the amount that seniors will have to pay for prescription drugs they buy at the pharmacy at $2000 a year.
- Caps the amount that seniors will pay for insulin at $35 for a month’s supply.
- Provides access to a number of additional free vaccines, including the shingles vaccine, for Medicare beneficiaries.
- Will further lower prescription drug costs for seniors by allowing Medicare to negotiate the price of high-cost drugs and requiring drug manufacturers to pay Medicare a rebate when they raise prices faster than inflation.
From CMS.gov/newsroom, People with Medicare drug coverage will pay nothing out-of-pocket for adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), including the shingles and Tetanus-Diphtheria-Whooping Cough vaccines, starting in 2023.
2023 Arcadia 360 Is Up and Running
Medicare Advantage
- The 2023 Arcadia 360 is ready and available for providers. There are no form content changes for 2023 at this time. (Providers have already begun submitting 360s through Arcadia for 2023.)
- One known issue: pre-population from 2022 forms into 2023 forms is not currently working. This will be resolved with a new release coming this week. Exact release details and timing will be communicated once tested and confirmed. This applies to the following fields: past medical history, surgical history, allergies, medications, family history.
- The conditions tab and measures tab will populate with data as expected, if applicable.
UHC Relief At Last!!
Finally, Some United HealthCare Relief!
As of this morning POET has acquired a list from UHC regarding the products for our Agreement.
If you are having issues with any par plans on this list. Please email a copy of the card and patients date of birth to [email protected]. Include a brief description of the issue.
Remember this information is confidential and pertains only to the POET Agreement.
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