CMS Increased Payment for Influenza Vaccines
On August 1, the Centers of Medicare and Medicaid Services (CMS) increased payments to physicians for influenza vaccines and updated which codes physicians should use when billing for the service during the 2024-25 flu season.
Texas Medical Association billing and coding staff caution that to receive payment, physicians also will need to use a national drug code (NDC) associated with the current period.
Follow this link for proper CPT codes and more vaccine information.
Revisions to Medicare Part B Coverage of Pneumococcal Vaccinations Policy
Co-pays Resuming for Certain Services
Effective 10/1/24: Co-pays will Resume for CHIP CoVid19 Services.
During the COVID-19 public health emergency, the Texas Health and Human Services Commission (HHSC) waived co-pays for COVID-19 vaccines, testing, and treatment for Children’s Health Insurance Program (CHIP) members. This waiver will end on September 30, 2024
Providers may begin collecting co-pays for COVID-19 vaccines, testing, and treatment rendered to CHIP eligible members for dates of service on or after October 1, 2024.
Providers may not charge co-pays for mental health and substance use disorder outpatient office visits
Co-pays have been permanently removed for mental health and substance use disorder outpatient office visits to comply with federal regulations.
Information for Medicaid Providers
Upcoming Changes to STAR+PLUS
Effective September 1, HHSC is transitioning contracts for the STAR+PLUS program. Below are a few resources that may help.
If you need help with….
Try…
Managed Organization Complaints.
Knowing how this transition will impact my billing.
Please reach out to the MCO to understand their billing process.
Helping your clients through the transition.
See the HHSC Star+Plus webpage for transition resources.
For any STAR+PLUS transition related issues, please contact the STAR+PLUS Go Live Inbox.
And as always, contact POET if you have any concerns.
BCBSTX to Require E/M Codes for Consultation Services
Starting Nov. 18, Blue Cross and Blue Shield of Texas (BCBSTX) will no longer pay physicians for outpatient or inpatient consultations when they report those services with Current Procedural Terminology (CPT) codes 99242 – 99245 and 99252 – 99255.
Instead, the payer says physicians will need to report consultation services with an appropriate office outpatient or inpatient evaluation and management (E/M) code representing where the visit occurred and its level of complexity.
According to the health plan, consultation claims reported with CPT codes after Nov. 18 will be denied.
Updated 12/10/2024, to add BCBS website information
Evaluation and Management Coding – Professional Provider Services
Policy Number: CPCP024
Version 1.0
Enterprise Clinical Payment and Coding Policy Committee Approval Date:
August 7, 2024
Plan Effective Date: November 18, 2024
(Blue Cross and Blue Shield of Texas Only
Consultation(s) CPT Codes 99242-99245 ,99252-99255 Effective 11/18/2024, the plan will no longer reimburse for office/outpatient consultation codes (CPT codes 99242–99245) and inpatient consultation codes (CPT codes 99252–99255). Consultation services should be reported with an appropriate office/outpatient or inpatient E/M code representing the location where the visit occurred and the level of complexity of the visit performed, such as code ranges 99221-99223, 99304-99306, and 99202-99215.
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.
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