Blog Posts by Author: Clarisa Blattner
California Bill Passes that Prohibits Prior Authorization for Biomarker Testing in Cancer Patients
On October 6, 2021, Senate Bill No. 535 was approved by Governor Gavin Newsom and filed with the Secretary of State in California. The bill will prohibit health insurance and health plans from requiring prior authorization for biomarker testing for an insured individual with advanced or metastatic stage 3 or 4 cancer, as well as biomarker testing for cancer progression or recurrence in these...
Celebrating Telehealth Awareness Week and The Evolving Role of Telehealth in Diagnostics
This week we’re celebrating Telehealth Awareness Week. Telehealth has undoubtedly provided significant value to patients and providers throughout the COVID-19 public health emergency (PHE). Many hope that telehealth will continue to play an important role in healthcare well beyond the emergency caused by the pandemic.Telehealth technology provides health care providers, staff, and patients a way...
Q3 Industry Updates – News You Can Use
Welcome to a round up of relevant news that piqued my interest over the past 60 days: Select Aetna Updates Aetna announced that effective September 1, 2021, it will no longer pay for professional services performed in a hospital setting for technical-only procedure codes. The CMS Physician Fee Schedule lists these codes as diagnostic only. They do not have a related professional code. Note:...
First Coast Publishes Rates for New External Electrocardiographic Recording Codes
In late 2020, CMS announced that it would be moving from the temporary Category III codes for long term ECG monitoring and will instead use Category I CPT codes, starting January of 2021. CMS did not add national rates for the codes but is instead looking to the MACs to price individually.There has been much attention on the initial Novitas proposed rates as they were a substantial reduction and...
Payor Relations Insider: The Introduction of Turnaround Time Requirements for SARS–CoV–2 Testing
To ensure COVID testing is performed in as timely a manner as possible, CMS created a turnaround time-dependent reimbursement policy. Since its introduction in January 2021, many other payors have also adopted this pricing schema. The COVID-19 Public Health Emergency has created new burdens for clinical diagnostic laboratories. The results of these SARS-CoV-2 tests are used for critical treatment...
HRSA High Throughput COVID-19 Claims: Correction Timeline
HHS confirmed there was a system error in the reimbursement for high throughput COVID-19 PCR testing claims, with HCPCS U0003 and U0004, for the HRSA COVID-19 Uninsured Patient Program. HHS indicated on their FAQ page they would not implement the add-on reimbursement for HCPCS U0005 on January 1, 2021 and would continue reimbursing independent laboratories at the rate of $100 for COVID-19 PCR...
How Upcoming Changes to United Health’s Laboratory Test Registry May Impact Your Lab
Important Update:In response to the COVID-19 Public Health Emergency (PHE), UHC has made a decision to delay the implementation of the Laboratory Test Registry Protocol to January 1, 2022. Starting January 1, 2022 (Previously October 1, 2020, before the recent decision to delay), United Healthcare (UHC) requires in-network, free-standing, and outpatient hospital lab providers’ claims for test...