Billing News Jan 2017



Expansion of Radiology and Cardiology Notification/Prior Authorization Protocols to All Savers Plans (Offered Off-exchange) - Effective April 1, 2017

  • January 27, 2017

Effective April 1, 2017, care providers must provide notification prior to scheduling a planned service that is subject to UnitedHealthcare’s Outpatient Radiology Notification/Prior Authorization Protocol and Cardiology Notification/Prior Authorization Protocols for a UnitedHealthcare All Savers (offered off-exchange) member. These members...

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Diagnostic Mammography Coverage Mandate

  • January 27, 2017

There is a New York state coverage mandate going into effect January 1, 2017, expanding the existing health insurance benefit for screening mammography to include diagnostic imaging for the detection of breast cancer. The expanded services include diagnostic mammograms, breast ultrasounds, digital breast tomosynthesis and MRIs, in addition to...

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Retroactive Rate Adjustment of Electrocardiogram Claims

  • January 27, 2017

The Department of Health Care Services (DHCS) has updated provider reimbursement rates for CPT electrocardiogram codes 93000, 93005 and 93010. This update is effective retroactively for dates of service on or after November 1, 2014. No action is required on your part. Xerox State Healthcare, LLC (Xerox) will adjust the affected claims. These...

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McKesson Technology Solutions to rebrand as Change Healthcare after merger closes

  • January 27, 2017

McKesson Technology Solutions will be rebranded as Change Healthcare after its merger with Change Healthcare Holdings closes, ending speculation about the future branding of the health IT firm. The deal, which also recently passed federal antitrust review, is set to close in the first half of this year. Change Healthcare will offer software and...

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Rhode Island Working to Address Surprise Medical Billing

  • January 27, 2017

Rhode Island lawmakers have introduced legislation to help residents with medical billing. Democratic Rep. Robert Craven introduced a bill H5012 that would create a system to resolve medical billing disputes. The legislation aims to address unexpected insurance charges from emergency room visits and other services by out-of-network providers....

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Labs Stop VA from Allowing APRNs to Perform Lab Tests

  • January 27, 2017

The laboratory sector has successfully fought a Department of Veterans Affairs (VA) rule that would have allowed advanced practice registered nurses (APRNs) to “perform and supervise” lab testing. Numerous organizations, including the American Society for Clinical Laboratory Service (ASCLS), American Association for Clinical Chemistry...

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Obama administration dials back patient consent restrictions on Common Rule

  • January 27, 2017

The Obama administration is using its last few days in office to address a number of data privacy issues, most recently releasing a final rule that lifts a burden on scientists working with human subjects. The revised Common Rule, as it's known, dials back a proposal requiring researchers to get written consent from patients before using any...

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Anthem extends termination date of deal with Cigna to April 30

  • January 27, 2017

Anthem has elected to officially extend its contract deadline to merge with Cigna to the end of April, according to a Securities and Exchange Commission filing on Thursday. Sources have reportedly told the New York Post that the filing was done ahead of an expected court ruling against the $54 billion deal, raising speculation that Anthem wants to...

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