Tag: CMS (Medicare and Medicaid)
Prior Auth Changes, Superior
Prior Authorization Changes,
Effective September 1, 2021
New Codes Requiring Auths:
- 33270
- 33271
- 33274
Prior Auths Removed:
- 33273
- 93287
- 93290
In Accurate Medicare Claim DENIALS!!
Novitas Solutions, the Medicare payer for Texas, announced that a system error has caused the improper rejection of Medicare Part B claims submitted on or after July 6. Physicians who received a claim rejection message should not resubmit claims at this time. Novitas says it is researching a claims processing system fix. TMA is monitoring the problem.
HOSPITALS ARE REQUIRED!!
As of May 1, hospitals are now REQUIRED to electronically share their admit, discharge, and/or transfer (ADT) notices with the patient’s established primary care physician (pcp), group, or other practitioner identified by the patient.
As part of the same rule, PHYSICIANS ARE REQUIRED to update their digital contact information in the National Plan and Provider Enumeration System so hospitals have the information they need to electronically send the ADT notices.
From CMS.Gov
Critical Care Evaluation & Management Services: Comparative Billing Report in May
In late May, CMS will issue a second letter in the Special Edition Comparative Billing Report (CBR) series on Part B claims for critical care evaluation & management services. Use the data-driven tables to compare your billing and payment patterns with peers in your state and across the nation.
The public can’t view CBRs. Look for an email from [email protected] to access your report. Update your email address in the Provider Enrollment, Chain, and Ownership System to ensure delivery.
More Information:
- View a webinar recording
- Visit the CBR website
- Register for a live webinar on June 9 from 3-4 pm ET
Reload document 
Open in new tab Special Enrollments Periods
SEP for Individuals Affected by a Disaster or Emergency
Effective January 1, 2021, an SEP exists for individuals affected by a disaster or other emergency declared by a Federal, state or local government entity who were unable to, and did not make an election during another valid election period. This includes both enrollment and disenrollment elections.
THRIVE
THRIVE CareAllies’ Provider Newsletter May 2021
Education inside: Obtain Assistance with Coding Accuracy and Documentation, one-on-one education, coding reference tools. Get set up for remote access, email [email protected].
Resource Material inside:
- CoVid Vaccine Flyers
- Call us first: Poster, Wallet Card, Wearable Button, etc.
- NO-SHOW: Poster and Wallet Card (customizable)
Email CareAllies at [email protected] with any topic suggestions for this (your) newsletter.
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
New Resources Available on QPP Website
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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:
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News from UHC
UnitedHealthcare remains committed to delivering timely news and updates to help you stay informed of fast-changing COVID-19 circumstances. Here’s a quick overview of the recent extension of the national public health emergency period, as well as billing updates and resources to help you answer patient questions about COVID-19 vaccines. For the complete article follow this link to the InK Files.
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