Billing News Dec 2018



Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2019

  • December 4, 2018

CMS issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2019. For CY 2019 and CY 2020, CMS will continue the current coding and payment structure for E/M office/outpatient visits and practitioners should...

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New Federal Law Targets Referrals to Substance Abuse Treatment Providers and Labs

  • December 4, 2018

On October 24, 2018, President Trump signed into law the new Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act. The SUPPORT Act contains a number of provisions aimed at addressing the opioid crisis. Section 8121 of the SUPPORT Act, separately referred to as the Eliminating...

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The Eliminating Kickbacks in Recovery Act: An Unprecedented Expansion of Anti-kickback Liability to Private-Pay Referrals?

  • December 4, 2018

In attempting to prohibit “patient brokering” in the narrow context of addiction treatment and recovery centers, Congress may have unwittingly passed an unprecedented expansion of federal prosecutorial authority over payment arrangements between providers and referral sources for private-pay patients. At base, EKRA seeks to impose criminal...

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MolDX: Genomic Health Oncotype DX Prostate Cancer Assay LCD – RH

  • December 4, 2018

The following JF Local Coverage Determination (LCD) has been revised under contractor numbers 02102 (AK), 02202 (ID), 02302 (OR), 02402 (WA), 03102 (AZ), 03202 (MT), 03302 (ND), 03402 (SD), 03502 (UT), 03602 (WY). Medicare Coverage Database (MCD) Number: L36368 LCD Title: MolDX: Genomic Health™ Oncotype DX® Prostate Cancer Assay Effective Date:...

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The MolDX: BDX-XL2 L37031 A/B MAC LCD was revised.

  • December 4, 2018

Revision Date 11/8/2018 Changed the title of the LCD to BDX-XL2 and all Xpresys references to BDX-XL2. Removed "The test is ordered by a physician certified in the XL2 Certification and Training Registry (CTR), and The following information is recorded: all clinical risk factors to calculate the Mayo, VA, and Brock cancer risk predictors; PET...

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MDxHealth Prostate Cancer Test Gains New York State Approval

  • December 4, 2018

The approval completes MDxHealth's state licensing requirements for SelectMDx, allowing the firm to offer the liquid biopsy test in all 50 US states. SelectMDx is a noninvasive urine-based molecular diagnostic assay to identify patients at increased risk of aggressive prostate cancer. The company hopes the test will help to reduce unnecessary MRI...

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Illumina, Blue Cross Blue Shield Association Partner on Precision Medicine Report

  • December 4, 2018

Illumina and the Blue Cross Blue Shield Association will partner in order to develop a better understanding of the state of precision medicine in the US. The companies said they plan to write a report on the utilization of precision medicine by early 2019 that details the availability and clinical understanding of DNA sequencing technologies,...

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Submitting Unlisted CPT or HCPCS Codes for Reimbursement

  • December 4, 2018

Effective for claims received on or after Jan. 1, 2019, UCare will deny the entire claim when any line on the claim is an unlisted HCPCS or CPT code submitted without supporting documentation. These denials will apply to all UCare products.  UCare will deny the line(s) that require(s) supporting documentation with the RARC code M127 -...

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