Personalized Medicine Coalition submits comments to CMS on the Potential Revisions to the Laboratory DOS Policy

  • Sep 28, 2017

PMC recognizes the need for a change to CMS' "laboratory date of service policy," which requires hospitals to manage the complex billing processes for many laboratory tests performed within 14 days after a patient's discharge from the hospital even if the test is performed at an outside laboratory. As PMC notes in the letter, the administrative challenges caused by this policy can lead to delayed...

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Appeals and overpayment requests for providers/suppliers affected by a natural disaster

  • Sep 28, 2017

If you were affected by Hurricanes Irma, Harvey, or Maria, and are unable to file a timely claims appeal, you can contact First Coast in writing to request an extension. Likewise, if you are unable to respond timely to a request for overpayment or need to appeal an overpayment request, you should contact First Coast in writing. All written requests for extensions of an appeal or overpayment...

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Anthem’s New Outpatient Imaging Policy will Hit Radiologists as Well as Hospitals

  • Sep 28, 2017

The Blues giant Anthem will no longer pay for MRIs and CT scans performed on an outpatient basis in hospitals across the country. Anthem is taking aim at a service line that can be far more expensive in a hospital than in a free-standing imaging center. For its fully insured members, Anthem will no longer pay for MRIs or CT scans delivered at hospitals in nine states this year, unless a...

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Provider Self-Service Technology for Denials - Instant Claim Denial Assistance

  • Sep 28, 2017

WPS GHA developed enhancements to their portal to assist providers when a claim has been denied. The Self-Service Denial Tool was launched in September 2017 and includes enhancements to the Claim Details page to provide assistance when you receive a denial you may not understand. Another enhancement to the WPS GHA portal is the Code Lookup tool located in the Claims topic center. Do you ever want...

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New Service Type or Address Request Form

  • Sep 28, 2017

Effective September 1, 2017, the Agency for Health Care Administration (Agency) replaced the New Location Code Request (July 2008) form with the New Service Type or Address Request Form (August 2017). Medicaid providers who are actively enrolled, have no restrictions, sanctions, or over payments, and meet all eligibility requirements can submit the New Service Type or Address Request Form to the...

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Authorization requirements for different types of members

  • Sep 28, 2017

Over the past two months, BCBSMI has received several authorization requests through the e-referral system for procedures for Blue Cross Blue Shield of Michigan PPO (commercial) members that didn’t require authorization. Keep in mind that the list of Services That Require Authorization for procedures that require authorization, as of July 31, 2017, applies only to Blue Cross Medicare Plus BlueSM...

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Accepting Payment from Patients with a Workers' Compensation Medicare Set-Aside Arrangement (WCMSA), a Liability Insurance Medicare Set-Aside Arrangement (LMSA), or a No-Fault Insurance Medicare Set-Aside Arrangement (NFMSA)

  • Sep 28, 2017

This article is based on information received from Medicare beneficiaries, their legal counsel, and other entities that assist these individuals indicating that physicians, providers, and other suppliers are often reluctant to accept payment directly from Medicare beneficiaries who state they have a Medicare Set-Aside Arrangement (MSA) and must pay for their services themselves. This article...

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AMA Quickly Issuing, Pricing New Proprietary Analyses Codes, but Will They Improve MDx Reimbursement?

  • Sep 28, 2017

The AMA has been rapidly issuing a new set of CPT codes at the request of test makers that want to more specifically track the use of their diagnostics for reimbursement purposes. The AMA CPT Editorial Panel last year began approving so-called Proprietary Laboratory Analyses (PLA) codes in response to CMS requirements for implementing the Protecting Access to Medicare Act (PAMA). The AMA began...

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