Change HealthCare!
Looking for answers? So is POET. We are looking for work-arounds. Hopefully we will have some up before closing today.
POTENTIAL SCAM Regarding Cigna MA
If you receive a fax from Cigna MA , like either of the below,
DO NOT RESPOND
This is a scam.
If you do receive one, please send a short email to Jim with Cigna MA, to make him aware.
Updated Clinical Prior Authorization
Assistance Chart Now Available
An update to the Clinical Prior Authorization Assistance Chart is available. The chart identifies which clinical prior authorization each MCO uses and whether the MCO uses all or some of the steps in the evaluation process.
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
UHC Provider Portal Authentication Changing
All UnitedHealthcare Provider Portal users will be required to update their One Healthcare ID authentication sign-in and recovery options to retain their portal access.
Code Selection and Level of Service Training
“CodingIntel” is launching new courses, and the first is E/M Expertise: Go Beyond the Basics!
“We’ve developed a four-module course intended for those with a strong E/M knowledge base. The content is supported by CMS and CPT citations. When the citations are definitive, you’ll have a definitive answer. When they aren’t, you’ll be able to explain the gray areas clearly.”
This isn’t an introductory course. Knowledge and experience in E/M codes and selection is a prerequisite for this course.
This course has 3.5 AAPC CEUs for those who view the entire course and have at least a 70% score on the post-test.
The 1st course will drop March 4, 2024. POET will post the link as soon as we get it.
Substance Use Disorder Patient Records
HHS Finalizes Rule Changing Regulations
The Department of Health and Human Services (HHS) finalized a rule making changes to the regulations governing the Confidentiality of Substance Use Disorder (SUD) Patient Records under 42 CFR part 2 (Part 2). HHS aligned many Part 2 regulations with HIPAA in accordance with language from the Coronavirus Aid, Relief, and Economic Security Act (CARES Act).
Changes included allowing a single consent for all future uses and disclosures of Part 2 records for treatment, payment, and operations; HIPAA covered entities and their business associates may redisclose records following HIPAA regulations under this consent. The rule aligned Part 2 penalties and breach notification requirements with HIPAA, and restricted the use of Part 2 records in certain civil or criminal proceedings against patients without their consent or a court order.
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