Tag: Coding
Invitation to Test New 360 Feature
CIGNAFORHCP.COM MODERATION
You are invited to test the new Claims 360 Feature.
· Search for claims using your Tax Identification Number (TIN)
· Search by claim number
· Filter and focus on the claims you want to see
The Most Asked Questions About Medical Coding Audits Following the 2021 E/M and MDM Changes ~MGMA
In the above linked article you will find:
- What E/M Updates to Watch
The definition of “external” for purposes of reviewing data as part of MDM.
What is time-based coding?
Documentation Tips
- And More
TWO New Measures for Part C Stars
The Part C Stars Specification Overview has been updated for 2022 Dates of Service.
It includes two new measures –
- Follow-Up After Emergency Dept Visit for People with Multiple High-Risk Chronic Conditions (FMC)
- and Transition of Care (TRC).
Aetna 3rd-Party Claim and Code Review
Beginning June 1, 2022, you may see new claim edits.
According to March 1, 2022 Aetna OfficeLink Updates: These are part of our Third-Party Claim and Code Review Program. These edits support our continuing effort to process claims accurately for our commercial, Medicare and Student Health members. You can view these edits on our Availity provider portal.*
You can view any of these edits on Aetna’s Availity® provider portal.
For coding changes, go to:
- Aetna Payer Space
- Resources
- Expanded Claim Edits
Except for Student Health, you’ll also have access to Aetna’s code edit lookup tools. To find out if our new claim edits will apply to your claim, log in to our Availity provider portal. You’ll need to know your Aetna® provider ID number (PIN) to access our code edit lookup tools
Here is what POET found with 2022 effective dates:
Quarterly Update for Clinical Laboratory Fee Schedule (CLFS)
Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment
UnitedHealthCare Network News
Effective Feb. 4, 2022, UHC will no longer print and mail paper provider remittance advice (PRAs) for medical claims to network health care professionals.
UHC has updated their codes for the Outpatient Procedure Grouper (OPG) mapping. They have deleted 30 old codes and added 31 new codes. For more information follow this link.
Regarding New Telehealth Code
NOT ALL HEALTH PLANS ARE RECOGNIZING THE NEW TELEHEALTH CODE
TMA staff recommend you check with health plans directly to find out if they recognize the following:
- POS 10, a new Centers for Medicare & Medicaid Services code that corresponds to telehealth provided to patients at home, set to take effect on April 4.
- Modifier 93, an American Medical Association CPT code modifier now in effect that corresponds with a real-time medical service delivered by telephone or another audio-only technology.
Also not yet recognized by all health plans are the following Healthcare Common Procedure Coding System modifiers:
- Modifier FQ (furnished using audio-only communication technology);
- Modifier FR (supervising practitioner was present through two-way communication technology with both audio and video); and
- Modifier FT (unrelated evaluation and management during a postoperative period, or on the same day as a procedure or another evaluation and management visit).
TMA reimbursement specialists are keeping watch on insurers’ recognition of codes and modifiers. TMA’s Health Plan News page will post new developments as they emerge; for example, as noted on the Health Plan News page, Humana is recognizing modifier FQ.
Continue to read Texas Medicine Today for updates.
CPT copyright American Medical Association. All rights reserved.
Last Updated On January 20, 2022
Recent Comments