Billing News Jul 2016



Proposed 2017 MPFS Published

  • July 28, 2016

CMS has released the 2017 MPFS and the entire CMS document is published in the Federal Register. In 2015, Congress passed the Consolidated Appropriations Act of 2016, which included a provision that CMS lower the existing 25% professional component MPPR payment reduction to 5%, effective 2017. This reduction in the MPPR becomes effective...

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FDA Releases Draft Guidance Outlining Principles of Drug/Diagnostic Codevelopment

  • July 28, 2016

The US Food and Drug Administration released a draft guidance on the principles of drug and diagnostic codevelopment as a practical framework for sponsors advancing a therapeutic alongside a companion test and for agency staff reviewing these products. "Codevelopment of IVD companion diagnostics and therapeutic products is critical to the...

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Why the Justice Department rejected the Aetna and Anthem deals

  • July 28, 2016

After more than a year of scrutiny, the U.S. Justice Department filed requests for preliminary injunctions to block the two health insurance deals led by Aetna and Anthem that would shrink the number of national carriers from five to three if allowed to proceed. For the past year, Aetna has pursued its $37 billion acquisition of Humana to bolster...

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FDA advances Precision Medicine Initiative by issuing draft guidance's on next generation sequencing-based tests

  • July 28, 2016

In support of the President’s Precision Medicine Initiative, the U.S. Food and Drug Administration issued two draft guidance's that, when finalized, will provide a flexible and streamlined approach to the oversight of tests that detect medically important differences in a person’s genomic makeup. The powerful new technology, known...

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Proposed Medicare 2017 Reimbursement Schedule Hits Biopsy Payments; Digital Pathology Payments Up

  • July 28, 2016

The Proposed Medicare Physician Fee Schedule (MPFS) for 2017 includes a 15% cut to the technical component for CPT 88305. In a nutshell, the Proposed MPFS for 2017 includes some significant cuts to technical reimbursement for several key pathology codes, while proposed reimbursement for most professional services is little changed. CMS is...

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New Regional Contracts to Administer the TRICARE Benefit

  • July 28, 2016

The U.S. Department of Defense cut out former Tricare West Region contractor UnitedHealthcare and has given the contract to Health Net Federal Services, which also manages the Tricare North Region. In addition, in the move to cut costs by paring down the number of Tricare regions from three to two, Humana was awarded the contract to manage not...

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Genetic Testing and Counseling Program-Coverage policy updates

  • July 28, 2016

Cigna began their genetic counseling program in 2013 as a medically necessary requirement for customers undergoing specific genetic testing. It requires the counseling to be performed by a participating, independent board-certified genetic counselor or clinical geneticist prior to requesting precertification for the testing. Cigna will update the...

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Electronic Payments & Statements Users: Oxford Check Number Changed

  • July 28, 2016

As a result of an enhancement to allow care providers to be paid electronically at the National Provider Identifier (NPI) level via Electronic Payments & Statements (EPS), the Oxford check numbers returned on the 835 and electronic provider remittance advice (PRA) no longer match the check numbers shown on OxfordHealth.com. This means that a...

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