Can Your Employee Handbook Get You In Trouble?
Many healthcare businesses have an employee handbook, but fail to update them on a regular basis.
There have been a large number of changes to employment law, over the past couple of years.
HHSC Extends Postpartum Coverage.
Effective March 12, 2024, women enrolled in Medicaid or CHIP who are pregnant or become pregnant will be automatically enrolled for 12 months of postpartum coverage (formerly only 2 months).
Medicaid or CHIP coverage will be automatically extended to women while pregnant and still within their 12-month postpartum period if they are still residents of Texas. Coverage will be reinstated for the remainder of the 12-month postpartum period.
New! Search Tool Helps Streamline Prior Auths
Prior authorizations are often cited as one of the top burdens for healthcare professionals. To help streamline your workflow and save time, Humana has launched a new prior authorization search tool.
Now you can search by CPT® code, procedure or drug name to determine if authorization is required. You also can find guidance on how to submit medical and pharmacy authorizations.
UHC Network News August Edition
To view these updates, click the blue button to the right.
Superior Records Retrieval Project
It is always good to know things before they occur. But often we are scrambling for information after the fact.
NOT THIS TIME
Superior gives us a Heads Up.
Superior is requesting your cooperation in providing access to specific member records to facilitate a Risk Adjustment chart review. Risk Adjustment is the payment methodology used by CMS and HHS for Wellcare By Allwell and STAR+PLUS Medicare-Medicaid Plan.
The purpose of these chart reviews is to verify that information reported to Superior, and ultimately to CMS and HHS via claims or encounter data, includes all pertinent diagnosis codes at accurate levels of specificity.
Please Note: Superior has executed a Business Associate Agreement with both Advantmed and Datavant (formerly CIOX Health).
Advantmed and Datavant have been engaged by Superior to retrieve medical records selected as part of this chart review. Any information shared during this review will be kept in the strictest of confidence, in accordance with all applicable state and federal laws regarding the confidentiality of patient records, including current HIPAA requirements. Superior appreciates your cooperation with this and will work with you to minimize disruptions in member care.
You will have the option to submit medical records in the following ways:
- Secure email
- Fax
- FedEx
- Remote Electronic Medical Record (EMR) download
AND
- Onsite scanning performed by an Advantmed medical record technician
Tell your staff to anticipate a call or fax from Advantmed or Datavant to schedule the medical record retrieval in the upcoming weeks.
For any questions, please email [email protected]
Have Questions About Capturing Telehealth Visits?
Teleheath appears to become increasingly complex on a daily basis.
The following is a list of guidelines provided by MGMA:
Click on the title to follow the link.
Humana Physician News Q2 2024 Newsletter
NEW! 2024 preauthorization lists (PAL) and notification requirements Lists of services and medications, effective July 1, 2024, that may require preauthorization for patients with Medicare Advantage, Medicaid, dual Medicare-Medicaid and commercial coverage are now available.
NEW! 2024 provider manuals Humana Medicare and Medicaid provider manuals, effective March 15, 2024, are now available.*
Quality and Stars learning series Humana provides educational webinars each month, covering Quality and Stars-related topics for both learning purposes and continuing education credits.
Good News, Bad News in Medicare 2025
A first look at the 2025 Physician Fee Schedule
The 2025 Physician Fee Schedule proposed rule is a study in contrasts. If you’re the kind of person who can see both sides of an issue, this rule is for you.
Good News
Bad News
Practitioners doing telehealth from their home can continue to use the practice address instead of their home address on claims for 2025
Without an act of Congress, for real time audio/visual visits on 1/1/2025 patients can no longer receive these services in their homes in all geographic areas. Patients must be in an underserved area and go to a facility setting for telehealth. (Unless Congress changes this in their end of year Consolidated Appropriations Act.)
16 new telehealth codes that can be selected based on Medical Decision Making (MDM) or time.
Medicare has given them a status indicator of invalid.
New HCPCS code for GIDXX for visit complexity inherent to in patient and observation services associated with a confirmed or inspected infectious disease. (GIDXX is a placeholder code, not a final code.)
Limiting use. “We anticipate the HCPCS code GIDXX would be reported by physicians with special infectious disease training”
Can use G2211 when you use modifier 25 for an E/M and wellness visit on the same day, immunizations, and other preventive medicine services.
That’s the only exception.
Need Help Meeting all the Components of the Compliance Attestation. Here is Help.
Ever thought about how a confident, well-trained front office team could transform your healthcare practice?
MGMA is thrilled to present the best front-office training in practice management, designed to improve patient interactions and boost your team’s performance. Make this a priority in your onboarding process today!
Make it a Priority.
Ed Plus is the easy-button on staff training, and it’s extremely cost-effective. Courses include:
- It All Starts Here: Front Office Mastery
- An Overview of Culturally Competent Care
- Controlling Healthcare Workplace Violence
- Dealing With Disruptive Patients
- Diversity, Equity, and Inclusion in the Healthcare Workplace
- Employment Law for Medical Practices
- Establishing and Maintaining a Healthcare Compliance Program
- Healthcare Fraud, Waste, and Abuse
- HIPAA Essentials for Medical Practices
- Keeping Up With Revenue Cycle Compliance
- Lean Leadership
- OSHA Bloodborne Pathogens Standard
- OSHA for Medical Practices
- Revenue Cycle Compliance and Fraud
- Safety First: Keeping Your Workplace Safe
- Sexual Harassment in the Workplace
Front Office Training Exclusively in Ed Plus, Follow this Link for more information.
Digital Precertification on CignaforHCP.com
- Beginning July 18, 2024, registered users with the Precertification – View and Submit entitlement have access to digital precertification correspondence via the Messaging Center on CignaforHCP.com.
- Digital correspondence notifies users when precertification letters are available, or when action is required to continue processing.
- Designate the following communication preferences by logging into CignaforHCP.com > Settings and Preferences > Communication Settings:
- The type of correspondence you want to receive (e.g., emails and/or alerts) when digital correspondence is available.
- Email notifications and frequency to alert you when new digital correspondence is available.
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