SARS-CoV-2/2019 Lab Testing
CMS develops the First HCPCS Code for testing for Coronavirus
From MGMA GovChat 3/6/2020, Drew Voytal
Last month, CMS developed the first HCPCS code (U0001) to bill for tests and track new cases of the virus. This code is used specifically for CDC testing laboratories to test patients for SARS-CoV-2. The second HCPCS billing code (U0002) allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19). On February 29, 2020, the Food and Drug Administration (FDA) issued a new, streamlined policy for certain laboratories to develop their own validated COVID-19 diagnostics. This second HCPCS code may be used for tests developed by these additional laboratories when submitting claims to Medicare or health insurers. CMS expects that having specific codes for these tests will encourage testing and improve tracking.
The Medicare claims processing systems will be able to accept these codes starting on April 1, 2020, for dates of service on or after February 4, 2020. Local Medicare Administrative Contractors (MACs) are responsible for developing the payment amount for claims they receive for these newly created HCPCS codes in their respective jurisdictions until Medicare establishes national payment rates. Laboratories may seek guidance from their MAC on payment for these tests prior to billing for them. As with other laboratory tests, there is generally no beneficiary cost sharing under Original Medicare.
Update 3/10/2020: To follow up to the previous post, I am sharing new CMS FAQs for Medicare providers regarding Medicare payment for lab tests, drugs/vaccines, and physician and hospital services. As new Medicare COVID-19 resources become available I will be sure to post them here, and as always please feel free to reach out with any questions.
Thank you,
Drew
Announcing Alegis Care Complex Care Program
Cigna/HealthSpring/CareAllies
In a continued effort to positively impact the overall well-being of their members, Cigna Medicare is excited to announce an additional program in partnership with Alegis Care. They are introducing the Complex Care Program (CCP) program in the NETX POD service area effective February 17, 2020. View or download a summary of the Alegis Care CCP Program.
Termination of the Patient-Physician Relationship.
TMA Office of the General Counsel, September 2017
The patient-physician relationship is grounded in the personal relationship that exists between the physician and the patient. The patient-physician relationship is the result of a contract between a physician and a patient that the doctor will treat the patient with proper professional skill. Although the relationship is contract-based, the contract need not be formal — it can be implied, which means the acts and conduct of the parties demonstrated there was a mutual intention to contract. When that relationship becomes untenable for either party, dissolution of the relationship may become necessary. While both the physician and the patient have the right to terminate the relation-ship, the requirements for termination are more complicated for physicians than for patients.
This white paper discusses the general legal and ethical issues related to termination of the patient-physician relationship. And it includes a form letter.
Provider – Patient
Relationship Termination Checklist, MGMA 2/6/2019
Firing a patient is never a task we like to undertake. Unfortunately, sometimes it cannot be avoided. MGMA has provided a checklist for just such instances. POET Ink is building a file called “Provider-Patient Relationship. You can locate that file in “The Business End”.
Inportant Information from Aetna OfficeLink Updates 3/1/2020
Changes and Updates include:
- Aetna’s National Pre-certification List, effective 7/1/2020
- Updates to Aetna’s Commercial Drug List, effective 7/1/2020
- Availity the will be Aetna’s sole Provider Portal, effective 4/30/2020
- Individual Service Codes and Service Grouping Updates, effective 6/1/2020
- Updates for In-Office Surgical Pathology Codes, effective 6/1/2020
- Updates to Drug test Thresholds, Billable Service, Notification for Acute Rehabilitation and Skilled Nursing Facilities and New Claim Edits, etc.
Heads UP – Last Day 3/31/2020
HEADS UP!!
Regarding Cigna MA:
Last day to submit new or correct 360’s for 2019 is March 31, 2020.
Behavioral Health Program Changes for BCBS Effective 6/1/2020
Behavioral Health Program Changes for Some Provider Networks (Corrected)
Starting June 1, 2020, Blue Cross and Blue Shield of Texas (BCBSTX) will administer behavioral health benefits for members enrolled in our Blue EssentialsSM, Blue Essentials AccessSM, Blue PremierSM and Blue Premier AccessSM provider networks. Magellan Healthcare® will no longer administer behavioral health benefits for these members.
Please forgive us for a double post. The original letter from BCBS (posted 2/27/20) left out HealthSelect. To read the corrected article please follow this link.
FYI – Well Care
Many of you are receiving contracts from WellCare for Medicare Advantage etc. WellCare has recently been acquired by Centene.
Centene also owns Superior. POET has a contract with Superior presently for Medicaid only. However, we are working on other products with them also.
Reporting System Makes Documenting PMP Checks Easy.
By David Doolittle, TMA
As you probably already know, beginning March 1, you’ll be required to check the Texas Prescription Monitoring Program, known as PMP Aware, any time you prescribe opioids, benzodiazepines, barbiturates, or carisoprodol.
BCBS Speaks on the Importance of Checking Eligibility and Benefits
As a reminder, it is important to check eligibility and benefits before rendering services. This step will help you determine if benefit prior authorization is required for a member. For additional information, such as definitions and links to helpful resources, refer to the Eligibility and Benefits section on BCBSTX’s provider website.
Please note that verification of eligibility and benefits, and/or the fact that a service or treatment has been preauthorized or predetermined for benefits is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have questions, contact the number on the member’s ID card.
Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX.BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by Availity, Aerial or Medecision. The vendors are solely responsible for the products or services they offer. If you have any questions regarding any of the products or services they offer, you should contact the vendor(s) directly.
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