A pair of big wins capped a successful past week for medicine, as the Texas House of Representatives on Friday afternoon signed off on both curbing the impositions of prior authorization and updating the state’s immunization registry.
House Passes Prior Auth, ImmTrac2 Improvement
Haters of preauthorization burdens – and if you’re reading this, chances are you’re among them – will celebrate the House’s passage of House Bill 3459 by Rep. Greg Bonnen, MD (R-Friendswood). The bill attacks the plague of prior authorization requirements in two major ways.
First, for certain services, if a physician earns insurer approval on 80% of preauthorization requests for the service in one calendar year, the doctor will be exempt from preauthorization for that service in the next calendar year. HB 3459 would allow physicians to gain those exemptions on an every-other-year cycle
E&M Coding in 2021
Now is the time to take a few minutes to assess your coding.
- If you are coding close to your specialty’s bell curve and if your documentation supports your coding, take a deep breath. If you find you are an outlier, don’t panic. Time is on your side.
- Under-coders of the world, look to increase your coding. Your documentation likely supports a higher code. Over-coders, make sure your documentation supports your higher coding.
- You are at higher risk for an audit, and your best defense will be solid documentation
Are you curious to see how you are doing? Follow this link to “Physicians Practice” article:
E&M Coding in 2021: Four Questions, Four Answers
Physicians Practice
COVID-19 Coverage Assistance Fund (CAF)
MGMA Washington Connection May 6, 2021
This week, the HHS Health Resources and Services Administration (HRSA) announced the creation of the COVID-19 Coverage Assistance Fund (CAF). This new program will reimburse providers the cost of administering COVID-19 vaccines to patients specifically enrolled in certain short-term, limited duration and benefit health plans that either do not cover vaccinations or cover them with patient cost-sharing. Providers can request claims reimbursement electronically through the CAF Portal and will be reimbursed at the national Medicare rate for vaccine administration, and for patient charges related to COVID-19 vaccination, including co-payments, deductibles, and co-insurance for vaccine administration.
As a reminder to those practices that have received more than $10,000 from the Provider Relief Fund (PRF), registration is now open for the PRF Reporting Portal. According to HRSA, the portal is only open for registration. MGMA will update members once the portal is open for reporting.
Re: Cigna MA Referrals
This is a cut and paste from:
(Revised 04/26/21) The current Public Health Emergency (PHE) period has been extended through 07/20/2021. https://www.phe.gov/emergency/news/healthactions/phe/Pages/COVID-15April2021.aspx
Referral Requirements
In-Network Providers: Referral requirements (if required by customer’s benefit plan) are waived for in-network provider services through 07/20/2021.
Out of Network Providers: Referral requirements (if required by customer’s benefit plan) are waived for out-of-network provider services through 07/20/2021.
Cigna MA Referral Requirements
UnitedHealthCare
Looking for UHC updates?
- Medical Policy Updates
- Reimbursement Policy Updates
- Looking to review all the updates?
See the monthly overview
UHC Bulletin
Before Endorsing Checks
If you haven’t read anything this year please read this!
Physicians should be aware of a practice by TRPN DirectPay whereby the out-of-state contracting entity sends checks that may be mistaken as an insurance payment, but instead attempt to have physician practices agree to a binding network participation agreement.
New Resources Available on QPP Website
|
Over the past few weeks, CMS has added new resources to the Quality Payment Program (QPP) Resource Library. For performance year 2021, the new batch of resources includes:
|
Quality Payment Program
Important, Time Sensitive
WEDI is hosting a day-long virtual meeting on Wednesday, April 28 to review the Information Blocking regulations, exceptions, and discuss compliance plans. Here you can find registration and the agenda for the event.
This event on Information Blocking is free for all members of the healthcare industry.
Recent Comments