Tag: CMS (Medicare and Medicaid)
Don’t Miss UHC Updates
Texas Medicaid: Adjustment reimbursement methods coming soon
Texas Medicaid: Prior autorization updates for certain medications
Receive More Accurate Payment for Medicare Complex Visits.
The new code will take effect Jan. 1, 2024. The 2024 Medicare Physician Fee Schedule allows physicians to list G2211 in addition to codes used in-office or outpatient visits for new or established patients (i.e., 99202-99215). Physicians can also use it for telehealth visits.
Texas Medical Association continues to push for additional guidance as confusion over the code’s use persists.
CMS Extends Telehealth Flexibilities to Protect Physician Privacy.
Following staunch advocacy by the Texas Medical Association, the Centers for Medicare & Medicaid Services (CMS) will not require physicians to list their home address as a practice location on Medicare enrollment forms for another year when providing telehealth services, safeguarding their privacy and safety.
During the COVID-19 pandemic, CMS allowed physicians to offer telehealth services from their homes without reporting their home address on their Medicare enrollment. However, that flexibility was set to expire Dec. 31.
MLN Connects News
2024 Medicare Part B Deductible.
The annual deductible for all Medicare Part B beneficiaries will be $240 in 2024, an increase of $14 from the annual deductible of $226 in 2023.
Discarded Drugs and Biologicals:
When to Use JW and JZ Modifiers.
Read updated JW and JZ Modifier FAQs for additional clarity on billing with these modifiers (see FAQs 7, 8, and 18–22). CMS posted a new list of billing and payment codes only used for single-dose containers that may require the modifiers, depending on the setting:
Medicare Advantage Audits
In response, the Texas Medical Association has developed free CME to help member physicians prepare for such audits.
Renewed Form for ABN
The ABN, Form CMS-R-131, and form instructions have been approved by the Office of Management and Budget (OMB) for renewal. The use of the renewed form with the expiration date of 01/31/2026 will be MANDATORY on 6/30/23.
The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, is issued by providers to Original Medicare (fee for service – FFS) beneficiaries in situations where Medicare payment is expected to be denied.
The ABN is issued in order to transfer potential financial liability to the Medicare beneficiary in certain instances
CMS Efforts to Reduce Prior Auth Burden
Insurers must halve the length of time they take to respond to prior authorization requests
Insurers may no longer require preapproval for emergency behavioral healthcare.
Insurers have to explain denials and publish data on their decisions.
Patients in active treatment who change carriers must be given at least 90 days before the new insurer can require another prior authorization.
Click the below articles for more information.
UHC April Monthly Overview
For Texas:
Starting June 1, 2023, Optum will manage prior authorization and step therapy requests for prescription medications for Texas residents with pharmacy coverage.
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