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Blog Posts by Author: Clarisa Blattner

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: This...


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...