POET LLC

UHC Policy and Protocol Updates

AMA unveils anticipated E/M changes for facility-based services

The AMA set off its own fireworks during the Independence Day weekend with the early release of new E/M guidelines that will be included in the 2023 CPT manual and take effect Jan. 1, 2023

Beginning on that date, the format for office and other outpatient visits (99202-99215) will apply to hospital inpatient and observation visits, consults, and services in the emergency department, nursing facility, home and residence. As a result, history and physical examination will no longer contribute to the level for these visits. Instead, for most visits practices will select codes based on medical decision-making (MDM) or time. The only exception will be emergency department visits, which will be MDM-only because the codes do not have a time component.

Among the most radical changes, the AMA plans to delete all observation care codes (99217-99220, 99224-99226) and merge observation services with initial and subsequent hospital care codes (99221-99223, 99231-99233, and 99238-99239)

Cigna Delays Record Request Policy

You may have read the article posted May 23rd. Cigna (Commercial) had implemented a new policy that required medical records be sent when a minor procedure is billed with an office visit.

However, Cigna has delayed the Records Request Policy, Staving Off the “Administrative Nightmare” for now.

Cigna has delayed the implementation of a new billing policy after the Texas Medical Association and others in organized medicine pushed back, warning that it would have negative implications for physicians, practice staff, and patients.

Close those Gaps

CLOSE THOSE GAPS

Please fax documentation for closing Cigna MA 360 gaps

Attention: Leslie (866) 214-5122

Or

Email to [email protected]

UHC Network News

Do you and your staff have the UHC Prior Auth Blues?

Humana Contract Amendment

Deadline for responding to the Humana Amendment has past.

Notice to participants in the POET Humana PPO contract: If you have not responded, this will default to acceptance.

If you have any question, please contact POET

Is Cigna Stealing?

Several Members from the MGMA Community have reported that Cigna has made ACH withdrawals from their bank account without permission.

One POET physician has reported the same.

MGMA Members suggest you contact your bank if you see a non-approved withdrawal from your account.

Update from MGMA, 6/15/2022: Please be aware Cigna experienced an isolated issue resulting in some EFT payments from settlement date May 23 being paid over the amount of the remittance advice. To minimize disruption to providers, Cigna worked with the bank to retract these EFT payments on June 1, 2022. The EFT payments for the correct amounts will be reissued around June 8, 2022 and should be available within 1 business day from reissue. Please also note that during this time, some remittance advices were delayed but have since been released.

Looking to Start In House Meetings

The thought of having you guys back in our office is exhilarating!

Help us get this show back on the road!

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Where do you need the most help?
What training is your staff missing?

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2% Medicare Sequester

Back to the ax!

July 1, 2022, CMS will begin sequestering the full 2% off your Medicare payment.

Invitation to Test New 360 Feature

CIGNAFORHCP.COM MODERATION

You are invited to test the new Claims 360 Feature.

The new Claims 360 feature allows you to:

· Search for claims using your Tax Identification Number (TIN)

· Search by claim number

· Filter and focus on the claims you want to see