Tag: CoVID-19
Cigna Continues CoVid Accommodations
Over-the-counter testing
Consistent with new federal guidelines for private insurers, Cigna commercial will cover up to eight over-the-counter (OTC) diagnostic COVID-19 tests per month (per enrolled individual) with no out-of-pocket costs for the tests. This coverage began January 15, 2022 and continues through the end of the PHE (currently through April 15, 2022).
Please note that while Cigna Medicare Advantage plans do fully cover the costs for COVID-19 tests performed in a clinical setting, costs of at-home COVID-19 tests are not a covered benefit at this time.
Additionally, we encourage you to remind your patients that the Federal Government is now offering four free at-home test kits per household with no cost. Your patients can order the free at-home COVID-19 testing kits at COVIDtests.gov.
Coverage of COVID-19 treatments
As a reminder, Cigna commercial and Cigna Medicare Advantage cover FDA emergency use authorized (EUA) treatments of COVID-19, including monoclonal antibody treatments. This includes new antiviral medications PaxlovidTM and molnupiravir, as well as Remdesivir infusions when administered in an inpatient or outpatient setting.
Get all the most up-to-date information
We updated our dedicated COVID-19 provider web page on January 21, 2022 to highlight these updates more. You can also access the latest Cigna Medicare Advantage billing guidelines from this page. Please visit the site often to get the latest information.
The PHE Has Been Extended
The Public Health Emergency (PHE) has been extended for the eight time.
The federal Department of Health and Human Services (HHS) has extended the COVID-19 public health emergency (PHE) for another 90 days, which means many payer flexibilities are likely to continue as well. HHS Secretary Xavier Becerra issued the extension on Jan. 14, two days before the PHE was set to expire. The new extension runs through April 16. It is the eighth extension of the PHE since HHS originally declared the emergency in late January 2020. |
ICD-10 Adds Z Codes
Starting April 1, 2022
You will have new ICD-10-CM Z codes to report if you find the patient you are treating is partially vaccinated or unvaccinated for COVID-19.
- New subcategory Z28.31 (Underimmunization for COVID-19 status), and under it, two new patient status codes:
- Z28.310 (Unvaccinated for COVID-19).
- Z28.311 (Partially vaccinated for COVID-19).
- Z29.39 (Other underimmunization status).
MGMA Washington Connection
- COVID-19 PHE ends January 16, 2022 if HHS Secretary does not renew.
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MGMA successfully advocates for sunsetting of healthcare ETSOn Dec. 27, 2021, the Occupational Safety and Health Administration (OSHA) issued a statement on the status of its COVID-19 healthcare emergency temporary standard (ETS), confirming that it is withdrawing the ETS with the exception of the recordkeeping portions.Last August, MGMA urged OSHA to not make this standard permanent, due to it disrupting ongoing efforts of medical groups to balance the needs of patients against the imperative to protect employees. Although OSHA is letting this ETS sunset, it expressed its intentions to revisit the issue of protecting healthcare workers from COVID-19 in the future by issuing another standard. MGMA will urge the Agency to solicit input from stakeholders, such as medical groups, when developing such a standard.
- Updated member resources to navigate surprise billingOn Jan. 1, 2022, the No Surprises Act requirements prohibiting certain out-of-network balance billing and new uninsured (or self-pay) good faith estimate price transparency requirements took effect. Throughout 2021, the Biden Administration released several rules implementing these newly effective requirements. The Administration will continue to release additional rules throughout 2022 outlining the remaining patient protections that have not yet been implemented.The MGMA Government Affairs team has updated member-exclusive resources to help group practices better understand the requirements in place. Check out the most up-to-date resources on the MGMA Surprise Billing landing page.
- MIPS 2021 data submission window openClinicians can now submit and review data for the 2021 performance year for the Merit-based Incentive Payment System (MIPS). The data submission window closes on March 31, 2022 at 8 p.m. (ET). The Centers for Medicare and Medicaid Services provided several flexibilities for clinicians due to the COVID-19 public health emergency, including applying an automatic reweighting of performance scores for individual clinicians.
In other MIPS updates: on Jan 1. 2022, the 2022 payment adjustment, based on clinician 2020 MIPS performance scores took effect and will be applied to Part B covered services. Additionally, looking ahead to the 2022 performance year, clinicians can now review their preliminary MIPS eligibility by signing into the Quality Payment Program website.
CoVid Vaccine Mandate, Update
ADVOCACY RESOURCE – DECEMBER 2, 2021
Claire Ernst J.D.
Government Affairs Director MGMA
Washington DC
MGMA, Update on the Court Cases Involving CoVid-19 Vaccination Mandates.
Per Claire Ernst J.D., Government Affairs Director MGMA
“I wanted to provide a quick update on the court cases involving the COVID-19 vaccination mandates. As many of you have seen, both the OSHA vaccination and testing emergency temporary standard (ETS) and the CMS facilities vaccination mandate were quickly challenged in court. Below is a quick overview of where the mandates currently stand – this is subject to change:
- OSHA vaccination and testing ETS: On Nov. 12, 2021, the U.S. Circuit Court of Appeals for the Fifth Circuit granted a motion to stay (or halt) the ETS. After that decision, OSHA suspended enforcement pending future developments in the litigation. More information about OSHA’s announcement can be found on the ETS landing page. The U.S. Court of Appeals for the Sixth Circuit now has jurisdiction over the challenges and will issue its decision. However, it is certainly possible that following the Court’s ruling, the decision could get appealed to the U.S. Supreme Court.
- CMS facilities vaccination mandate: On Nov. 30, 2021, the U.S. District Court for the Western District of Louisiana issued a preliminary injunction halting the mandate. The ruling comes one day after the U.S. District Court for the Eastern District of Missouri halted implementation of the rule for 10 states. Together, the decisions apply to all states. However, this decision is likely to get appealed as well.
MGMA will continue to monitor this evolving situation and provide updates.”
CoVID-19 Vaccine Mandate
This regulation will not apply to physician’s offices because they are not subject to CMS health and safety regulations.
Nov 4, 2021, the Biden administration released two rules pertaining to COVID-19 vaccine mandates. Both rules will require applicable employers and healthcare facilities to fully meet vaccination requirements by Jan. 4, 2022
Humana Physician News-Q4 Edition
Effective Dec. 31, 2021, the Provider Payment Integrity (PPI) contact mailbox will be disabled.
To manage overpayments, please use the Availity Portal or call Customer Care at 800-438-7885, Monday – Friday, 8 a.m. – 8 p.m., Eastern time.
Looking for new ways to reach and engage your patients?
Humana has developed the Provider Marketing Resource Center (PMRC) so you can engage, retain and grow your practice’s patient panel, regardless of their current insurance carrier.
Contact [email protected] for access to their library of customizable patient marketing materials.
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