Prior authorization (PA) Policy Changes related to COVID-19

The information Prior authorization and guidance provided in this document are believed to be current and accurate at the time of posting this article. Major Medical Insurance Plans Plan Effective Date(s) Policies Aetna Check the Aetna COVID-19 Communications Update for state-specific information and detailed requirements 3/25/20 – 5/6/20 Transfers: Initial PAs waived in the following […]

Medicare Fee-for-Service (FFS) Billing for COVID-19 Specimen Collection

As part of the Public Health Emergency (PHE) for the COVID-19 pandemic and in an effort to be as expansive as possible within the current authorities to have diagnostic testing available to Medicare beneficiaries who need it, in the interim final rule with comment period, CMS is changing the Medicare Fee-for-Service (FFS) Billing rules during […]

Modifier -25 for Minor Retina Surgeries

The growth of intravitreal drug therapy for the treatment of retinal diseases over the past decade has been unprecedented. The number of intravitreal injections performed annually in the United States rose from less than 3000 in 1999 to more than 1 million in 2008, and it is estimated that more than 7 million intravitreal injections […]

Using Telehealth in Response to COVID-19

What is COVID-19? Coronavirus disease 2019 (COVID-19) is a novel coronavirus that has not been previously identified. Symptoms include cough, difficulty breathing, fever, and mild to severe respiratory illness. According to the Centers for Disease Control and Prevention (CDC), the virus currently seems to be easily spreading throughout communities in the United States (community spread), […]

FAQs on Medicare Billing for Physicians in COVID-19 Pandemic

CMS is revising certain Medicare regulations to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in the Medicare program during the public health emergency (PHE) resulting from the COVID-19 pandemic. To that end, the IFC makes temporary changes to certain policies that will affect Medicare billing […]

Newly Added Lab Specimen Collection HCPCS Codes COVID-19

CMS announced the creation of new COVID-19 lab specimen collection HCPCS codes G2023 and G2024 through their COVID-19 Interim Final Rule effective on and after March 01st, 2020. The rule specifies that these codes are only chargeable by independent laboratories and only in instances where trained personnel from the lab travel to collect the specimens […]

How to do accurate coding for Telehealth Services 2020?

The government is relaxing guidelines to ensure seniors get the healthcare they need during this national emergency. The Centers for Medicare & Medicaid Services (CMS) announced in a March 17, 2020, press release that it will make a temporary change in its reimbursement policy for telehealth services. For dates of service (DOS) on or after […]

Tracking Key Metrics for Laboratories and Diagnostic Providers

Tracking key metrics like clean claim and write-off rates is key to laboratories and diagnostic providers maximizing revenue. Submitting clean claims is one of the most important ways that a diagnostic organization can ensure payment in a timely manner from both private and government insurance payers. Receiving the maximum reimbursement the first time a claim […]

Newly Added CPT Codes for COVID-19 Antibody Tests

The American Medical Association (AMA) on April 10, 2020, announced updates to Current Procedural Terminology (CPT®) that include two CPT Codes for COVID-19 Antibody Tests, intended to report when patients receive blood tests that detect COVID-19 antibodies. The updates were approved during a special meeting of the CPT Editorial Panel, the independent body convened by […]

Upfront Medicare Reimbursement During COVID-19 Pandemics

Centers for Medicare & Medicaid Services (CMS) is announcing an expansion of its accelerated and advanced payment program for Medicare-participating health care providers and suppliers, to ensure they have the resources needed to combat the 2019 Novel Coronavirus. This program expansion, which includes changes from the recently enacted Coronavirus Aid, Relief, and Economic Security (CARES) […]

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