Tag: CoVID-19
Prior Auth. Time Frames
Several commercial payers have resumed prior authorization time frames and requirements that had been suspended because of the COVID-19 emergency, while others will continue to approve prior auth requests or suspend them for at least part of the year.
Below is an overview of some payers’ COVID-19 prior authorization policies as of April 2021: Click on the Links for more detail.
Blue Cross and Blue Shield of Texas ended approvals on services with existing prior authorizations on Dec. 31, 2020.
Aetna is approving prior authorization requests for commercial and Medicare Advantage members until the end of the plan year. “Authorization may be extended beyond the plan year, for a period of six months, if continued eligibility can be confirmed.”
Cigna resumed standard prior authorization time frames and requirements beginning April 1, 2021.
Humana resumed standard prior authorization time frames and requirements beginning April 1, 2021
UnitedHealthcare will not require prior authorization for most services through the national public health emergency period, currently scheduled to end April 20, 2021. Exceptions include medical and behavioral health services, post-acute care admissions, site of service reviews, and transfers to new providers. Prior authorizations for medical and behavioral health were not subject to extension on or after April 10, 2020.
Article written by Ellen Terry : https://www.texmed.org/TexasMedicineDetail.aspx?id=53502&utm_source=Informz&utm_medium=Email&utm_campaign=TMT&_zs=cPrdA1&_zl=CvCF6
6 Keys to Addressing Denials
6 keys to addressing denials in your medical practice’s revenue cycle
MGMA STAT – MARCH 18, 2021
The Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders, “Has your organization seen denials increase in 2021?”
- 69% said “yes.”
- 31% said “no.”
Common responses from respondents included payers not reimbursing for codes related to COVID-19 supplies, critical care claims and imaging CTs.
For those healthcare leaders who reported an increase in denials, the average increase in denials was 17%.
- Half responded that they increased by 1% to 10%.
- 34% said 11% to 20%.
- 12% who stated 21% to 30%.
The poll was conducted March 16, 2021, with 576 applicable responses.
For great tips and strategies to use, follow this link or visit “The Business End” folder located in the InK files.
6 Keys to Addressing Denials in Your Medical Practice’s Revenue Cycle, MGMA STAT – March 18, 2021
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Regarding the Ever Changing Telemedicine Guidelines.
KZA Telehealth Solutions Center
An up-to-date, comprehensive resource regarding
the ever-changing telemedicine guidelines.
KarenZupko and Associates, Inc. has been around for a long time.
They have shared a link to their website for updates to telehealth on the MGMA Community.
Please note, they update materials as changes are made by CMS.
So check back often!
There is a very nice chart on Payor Telehealth Policies and
lots more.
CoVid-19 Recovery Center:
Vaccine Billing and Coding Reference, MGMA 2021
For a listing of Vaccine names and their CPT Code, please follow this link to files on InK.
Select CoVid-19 Temporary Cost Share Wavers are Extended. UHC Feb. 26, 2021
To continue to meet your needs through the evolving COVID-19 health emergency, UnitedHealthcare is extending select COVID-19 treatment cost share waivers, which are summarized below. We also continue to make ongoing updates to our COVID-19 billing and reimbursement guidance with the latest information, including giving providers a way to look up member Medicare ID numbers when submitting COVID-19 vaccine administration claims to the Centers for Medicare & Medicaid Services (CMS) Medicare Administrative Contractor (MAC).
Link Recommended by MGMA Regarding Telehealth
CCHP helps you stay informed about telehealth-related laws, regulations and Medicaid programs. The map and search options below cover current laws and regulations for all fifty states and the District of Columbia. The information provided is only for research and informational purposes and should not be construed as legal counsel. Please consult with an attorney if you are seeking a legal opinion. To view the full report, visit the 50 State Report PDF.
*Please note that for the most part, states continue to keep their temporary telehealth COVID-19 emergency policies siloed from their permanent telehealth policies. These temporary policies are not included in the Fall 2020 report. In instances where the state has made policies permanent, CCHP has incorporated those policies into this interactive map tool.
Stay informed about COVID-19
Patients look to you to help them make the most informed health care decisions. We know your patients have a lot of questions about the COVID-19 vaccines – from their safety and effectiveness to where they can get a vaccination and more.
We’ve pulled together resources to help guide your patient conversations, direct them to vaccination locations in their area and reinforce the importance of continuing to wear masks.
Use the Vaccine Resource Locator
UnitedHealthcare has developed a ZIP-code tool to help members find FDA-authorized vaccine resources near them. The resources include information on who can get a vaccine, where vaccines are being given, how to schedule an appointment to get a vaccine and how to sign up for alerts.
Answer questions about the vaccine
Your patients are likely asking many questions about the COVID-19 vaccines. They look to you to help them make sense of what they’re hearing in the news and what they should consider in deciding whether or when to get vaccinated. We’ve gathered resources from the American Medical Association (AMA) and the Centers for Disease Control and Prevention (CDC) – the organizations you trust most to provide reliable information – in one spot for easy reference. You’ll find sample scripts to use with patients as well as news articles with information to help answer patient questions about the COVID-19 vaccines.
Encourage mask wearing
Even with COVID-19 vaccinations, it’s important that everyone continue to wear masks, social distance and wash hands frequently. We’ve partnered with the American Medical Association to help promote their “Mask Up” campaign and provide flyers and other materials that you can use in your office and on social media to remind patients about the importance of masking up. These resources may be particularly helpful for health care professionals located in states without mask mandates.
Check out Mask UP
Public Health Emergency Likely to Last Through 2021
TMA experts say the extension allows the Centers for Medicare & Medicaid Services (CMS) to maintain several COVID-19-related Medicare waivers and flexibilities, including paying the same rate for telemedicine visits as for in-person visits, and allowing use of audio-only
To view the entire article, visit the InK file: http://https://community.poetllc.org/download/2021-01-28-covid-19-health-emergency-likely-to-last-through-2021-health-officials-say-tma/
2021.01.28, COVID-19 Health Emergency Likely to Last Through 2021, Health Officials Say, TMA
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