Blog Posts by Tag: Regulatory
UHC Suspends Prior Auth Requirements for Trichomonas & Candida, Will Adopt CMS Billing Policy for Prostates on January 1, 2021
Suspension of Trichomonas and Candida Prior Auth Requirements Beginning Oct. 1, 2020, for all commercial and UnitedHealthcare Community Plan plans included in the genetic and molecular testing program, UHC will be suspending prior authorization and notification requirements for the following three genetic and molecular CPT codes performed in an outpatient setting: 87480: Infectious agent...
2021 CMS Proposed Medicare Physician Fee Schedule Released
On August 4, 2020 CMS released its 2021 proposed physician fee schedule. Unfortunately, under the proposed schedule, pathology and several other specialties would take the brunt of some significant reductions. This is largely the result of the redistributive effects of previously finalized changes to the office/outpatient E/M visits taking effect in 2021. The results of these reductions will have...
Is the FDA on a Dangerous Path? Overstepping LDT Authority Hampered COVID Response and Has Long Term Consequences for US Healthcare
As I recently discussed during my session at this year’s Executive War College, one important aspect of the COVID pandemic and laboratory testing during this time is how it exemplified the detrimental consequences of FDA overreach — which contributed in large part to testing delays and a hamstrung response in the outbreak’s early days — and how that overstepping poses risk going forward. On...
G0416 Prostate Update for Cigna: Go-Live August 18, 2020
As announced by Cigna earlier this summer, beginning August 18, 2020 Cigna will require pathology groups to submit G0416 for prostate needle biopsies instead of 88305. Prostate biopsies will no longer be reimbursed using the 88305.XIFIN confirmed with Cigna that this applies to all Cigna plans, not just a select few. Commercial payors aligning with CMS guidelines on G codes is becoming a trend...
Florida Society of Pathology Pushes to Retain PCCL Reimbursement from Medicaid
Florida Society of Pathology (FSP) held a call for members on July 15th to review the process the organization had taken upon learning the state’s Medicaid plan would no longer fund Professional Component of Clinical Laboratory (PCCL) reimbursement. Florida is among less than a handful of states, including California and Illinois, that sill receive reimbursement for PCCL charges for Medicaid...
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, 2021. A UHC representative informed XIFIN in a July 17, 2020 correspondence, “To ensure compliance with these requirements, free-standing and outpatient hospital lab providers should register their laboratory...
Time Is Running Out to Voice Concern over the SPA 20-0010 Amendment
Important: Public input on this controversial amendment must reach the DHCS no later than Monday, July 27, 2020, to guarantee consideration before SPA 20-0010 is submitted. See various ways to contact the DHCS at the end of this article. The Department of Health Care Services (DHCS) plans to submit its State Planned Amendment (SPA) 20-0010 to the Centers for Medicare & Medicaid Services (CMS...
Insurers Not Required to Reimburse COVID-19 Tests for Returning Workers
According to newly released guidelines from the Trump Administration, insurers will not have to cover COVID-19 screening tests mandated by employers for returning employees.Until these new guidelines, The Families First Coronavirus Response Act required insurers to cover COVID-19 testing without patient cost-sharing. The latest announcement said the law applies only to tests considered medically...
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