The Future of Medicare Program Integrity

  • Nov 7, 2019

CMS is developing a five-pillar program integrity strategy to modernize approach and protect Medicare for future generations. Stop Bad Actors. Work with law enforcement agencies to identify and take action on those who defraud the Medicare program. CMS, Office of the Inspector general (OIG), Department of Justice (DOJ), and the Unified Program Integrity Contractors (UPICs) jointly deliberate...

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Site-of-Service Medicare Reimbursement Led To More Hospital Testing

  • Nov 7, 2019

Researchers are suggesting site-neutral payments after their study found hospital testing increased after Medicare reimbursement increased for hospital outpatient providers. The Trump administration intends to continue on the path to site-neutral payment. The president recently signed an executive order directing the HHS Secretary to “ensure that Medicare payments and policies...

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Important Highlights from the NIST/OCR HIPAA Security Conference Last Week

  • Nov 7, 2019

In his keynote for the conference, OCR Director Roger Severino raised several important issues regarding the ongoing work of HHS with regard to HIPAA: HHS is considering whether “future billing information” should be considered protected health information (PHI) under HIPAA, for purposes of access, such that health care providers would have to provide the information pursuant to the right of...

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EU Researchers Awarded €3M to Develop POC Molecular Tests

  • Nov 7, 2019

The European Commission has awarded a team of researchers €3 million ($3.3 million) to develop diagnostic tools for infectious disease testing. The project, called "Towards an instrument-free future of molecular diagnostics at the point-of-care," has been funded through the EC's Horizon 2020 program. It is set to commence in January 2020 and run through the end of 2022. Investigators at the...

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ICD-10-CM Diagnosis Codes Added for BRAF Gene Analysis

  • Nov 7, 2019

Effective for dates of service on or after November 1, 2019, ICD-10-CM diagnosis codes C33, C34.00 – C34.92 are reimbursable when submitted with once-in-a-lifetime CPT code 81210: BRAF (B-Raf proto-oncogene, serine/threonine kinase), gene analysis, V600 variant(s).

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UnitedHealthcare Commercial Reimbursement Policy Updates- Molecular Pathology Policy, Professional

  • Nov 7, 2019

Effective Date: New Nov. 1, 2019 The new Molecular Pathology Policy will be effective beginning with dates of service on and after Nov. 1, 2019. As previously communicated, the AMA Claim Designation code or Abbreviated Gene Name should be reported in loop 2400 or SV101-7 field for electronic claims or Box 24 for paper claims. For identification, the ZZ qualifier is required in front of the...

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Judge Denies CMS Bid to Preserve Site-Neutral Payment Cuts While Awaiting Appeal

  • Nov 7, 2019

U.S. District Court Judge Rosemary Collyer said in an opinion delivered Monday that the Centers for Medicare & Medicaid Services (CMS) hasn’t given sufficient reason for a 60-day stay of her September ruling against the agency’s regulation on site-neutral payments.  Collyer’s original ruling vacated the $380 million in cuts to off-campus providers that went into effect Jan. 1...

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Colorado Unveils State-Led Public Insurance Option

  • Nov 7, 2019

Colorado officials proposed a public option for its state individual health insurance market, The Denver Post reports.  The plan, released Oct. 7, will be open for comment until Oct. 25 and is slated to go into effect in 2022. It was created by the state Division of Insurance and the state Department of Health Care Policy and Financing, under a directive from the state government...

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