Recent Business Intelligence Releases

  • Mar 18, 2020

CR #: BI-104295 Type: New Feature Universe Name: Adhoc-Procedure Code Level Analysis Notes: The Adhoc-Procedure Code Level Analysis universe has been enhanced with new objects: Submission Payor ID, Submission Payor Name, Submission Payor Type, Submission Payor Group Name, Aging Amount, Aging Bucket Sort, and Aging Bucket Group. Note that these new objects only apply to the...

Read


FDA Finalizes Guidances on CLIA Waiver Applications, 510(k) Dual Submissions

  • Mar 9, 2020

The US Food and Drug Administration (FDA) finalized two guidances providing recommendation for diagnostics makers looking to submit Clinical Laboratories Improvement Amendments (CLIA) waivers for their tests or conduct studies to support dual 510(k) and CLIA waiver by application submissions. CLIA Waiver Applications  FDA says its final guidance on CLIA waiver applications updates...

Read


CMS Proposes Penalties for MSP Reporting Violations

  • Mar 9, 2020

Centers for Medicare & Medicaid Services (CMS) published a proposed regulation in the Federal Register concerning the imposition of civil monetary penalties (CMPs) for failure to comply with reporting obligations under the Medicare Secondary Payer (MSP) laws. 85 Fed. Reg. 8793 (Feb. 18, 2020). As proposed, the rule would be prospective, applying only to violations that...

Read


More States Passing Laws to Preserve Provider Competition

  • Mar 9, 2020

Catalyst for Payment Reform (CPR) published this week an update to its 2014 report on state policies on provider market power published in conjunction with the National Academy of Social Insurance. Using the Database of State Laws Impacting Healthcare Cost and Quality, jointly developed by CPR and the Source on Healthcare Price and Competition at the UC Hastings College of the Law, the new...

Read


BCBS – Medical Policy Update

  • Mar 9, 2020

Posted 2/14/20 Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry Artificial Intervertebral Disc: Cervical Spine Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer Automated Ambulatory Blood Pressure Monitoring for the Diagnosis of Hypertension in Patients with Elevated Office Blood Pressure Balloon Sinuplasty...

Read


Blood Test Method May Predict Alzheimer’s Protein Deposits in Brain

  • Mar 9, 2020

Researchers report an advance in the development of a blood test that could help detect pathological Alzheimer’s disease in people who are showing signs of dementia. This approach could be less invasive and less costly than current brain imaging and spinal fluid tests. The blood test detects the abnormal accumulation of a form of tau protein known as phosphorylated-tau-181 (ptau181), which is a...

Read


House Committees Release Competing Surprise Medical Billing Legislative Proposals

  • Mar 9, 2020

On February 7, 2020, two House committees released competing proposed bills designed to shield patients from “surprise” medical bills. These bills, like others that were proposed last year, would protect patients from liability for fees charged by out-of-network physicians when patients receive care at in-network emergency departments. The proposal from the House Ways and Means Committee...

Read


BCBS – Basic Benefit and Medical Policy: Drug Testing in Pain Management and Substance Use Disorder Treatment

  • Mar 9, 2020

Established: 80305, 80306, 80307, G0480, G0481, G0482 G0483, G0659 Experimental: 80320-80377, 83992 Policy guidelines: One presumptive and one definitive test code may be billed per date of service. Billing guidelines of definitive drug testing: These guidelines are effective Oct. 1, 2019. Bill G0480 through G0483 and G0659 as appropriate, for the number of drug classes tested. Bill 80XXX...

Read