Billing News Jan 2019



Anticipated Adoption of 2019 HCPCS Updates

  • January 8, 2019

The 2019 updates to the Healthcare Common Procedure Coding System (HCPCS) Level II codes are anticipated to adopt in the first quarter of 2019. This update will be effective for Medi-Cal and all specialty programs under the fee-for-service program.

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CMS Proposes Fee Increase for Labs: Four Things to Know

  • January 8, 2019

CMS issued a notice to raise fees 20 percent for laboratories certified under the Clinical Laboratory Improvement Amendments, the agency said Dec. 28. Here are four things to know: 1. Under the CLIA statue, CMS must impose user fees to offset the costs of running the CLIA program. Laboratories are required to get CLIA certification from CMS to...

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Next Generation Sequencing NCD MLN Matters Article — New

  • January 8, 2019

National Coverage Determination (NCD90.2): Next Generation Sequencing (NGS) I. SUMMARY OF CHANGES: The purpose of this Change Request (CR) is to inform contractors that effective March 16, 2018, the Centers for Medicare & Medicaid Services covers diagnostic laboratory tests using next generation sequencing when performed in a Clinical...

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LSA 18-375 Radiology Rule

  • January 8, 2019

Amends 405 IAC 5-27-1 to update definitions and terminology. Amends 405 IAC 5-27-2 to clarify prior authorization and service limitations for radiologic procedures. Amends 405 IAC 5-27-3 to update definitions and terminology and revise Medicaid policy for computerized tomography scans. Amends 405 IAC 5-27-6 to update terminology and revise...

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AHA, AAMC Sue Trump Administration Over Site-neutral Payment Rule

  • January 8, 2019

Last month, the Centers for Medicare & Medicaid Services (CMS) finalized the 2019 Outpatient Prospective Payment System (OPPS) rule (PDF), which will gradually institute site-neutral payments in the Medicare program over the next two years. In a complaint filed in the U.S. District Court for the District of Columbia, the American...

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MolDX: Cystatin C Measurement Final LCD - Effective February 11, 2019

  • January 8, 2019

Medicare Coverage Database (MCD) Number/Contractor Determination Number: L37618 LCD Title: MolDX: Cystatin C Measurement Effective Date: February 11, 2019 Summary of LCD: Cystatin C is a low molecular weight protein produced by all nucleated cells in the body at a constant rate. It has been proposed and investigated as an improved marker of renal...

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Medicare Program: Clinical Laboratory Improvement Amendments (CLIA) of 1988 Fees (CMS-3356-NC)

  • January 8, 2019

The fact sheet discusses why CMS is increasing the CLIA fees for the first time in 20 years.  Based on the agency’s financial data review, they project that a 20 percent fee increase will sustain and maintain the CLIA program through FY 2021.  CMS is required to update the program’s fee schedule because current fees are no longer...

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Changes to Amount in Controversy (AIC) for Appeals in 2019

  • January 8, 2019

The claims value in dispute must meet the threshold for obtaining an Administrative Law Judge (ALJ) hearing and a judicial review in Federal District Court. This is called the “amount in controversy.” The amount in controversy is recalculated and published on an annual basis, and is identified in your appeal notice of decision. The AIC for...

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