Billing News Jan 2019



Non-Participating Family PACT Providers

  • January 8, 2019

Effective January 1, 2019, the Family Planning, Access, Care and Treatment (Family PACT) Program is deactivating providers who have not submitted a claim for Family PACT services for one year. Pursuant to Welfare and Institutions Code (W&I Code), Section 24005(i)(3): The department shall deactivate, immediately and without prior notice, (…)...

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UPMC, Highmark Breakup Making it Hard to do Enrollment for Seniors

  • January 8, 2019

A state-brokered agreement between the University of Pittsburgh Medical Center and Highmark Health—both of which serve as providers and insurers—ends June 30. That means starting in July, seniors who have selected Highmark Medicare Advantage plans will no longer have in-network access to UPMC hospitals and most UPMC doctors. (Highmark...

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ACLA Files Opening Brief in Appeal of PAMA Lawsuit

  • January 8, 2019

The American Clinical Laboratory Association Tuesday filed the opening brief in an appeal of its lawsuit over the implementation of new Medicare pricing for lab tests under the Protecting Access to Medicare Act, alleging that Health and Human Services Secretary Alex Azar's implementation of the law violated Congress's intent. 

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Veracyte Expands Early Access for Genomic Lung Disease Classifier

  • January 8, 2019

The 190-gene Envisia classifier combines RNA whole-transcriptome sequencing and machine learning to detect the genomic pattern of usual interstitial pneumonia, a hallmark of IPF, with 88 percent specificity and 70 percent sensitivity. The genomic test is performed on patient samples obtained through transbronchial biopsy, a nonsurgical...

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Ascension’s CIO on Joining Blockchain Pilot Project

  • January 8, 2019

Ascension and Aetna are the latest alliance members. They said the alliance is looking at how blockchain technology could help ensure up-to-date healthcare provider information is available in health plan provider directories, so patients can have the most accurate information possible. Gerry Lewis, Ascension senior vice president and CIO, spoke...

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Every Woman Counts Cervical Cancer Screening Update

  • January 8, 2019

Effective for dates of service on or after August 20, 2018, the Every Woman Counts (EWC) program includes primary human papillomavirus (HPV) testing as a screening strategy for women 30 to 65 years of age. The program recommends using the American Society for Colposcopy and Cervical Pathology (ASCCP) and the Society of Gynecologic Oncology (SGO)...

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IHCP to Revise Rates for Select Clinical Laboratory Services Based on 2019 Medicare Rates

  • January 8, 2019

Indiana Health Coverage Programs (IHCP) will adopt the 2019 Medicare rates for any clinical laboratory procedure code for which the IHCP’s current reimbursement rate exceeds the 2019 Medicare rate. These rate changes will be effective for dates of service (DOS) on or after January 1, 2019, and will be reflected on both the IHCP Professional Fee...

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Independent Clinical Laboratories in Maryland May Need to Step-Up Outreach with Hospitals as New CMS Program Launches Jan. 1

  • January 8, 2019

The state’s All-Payer Medicare program—the nation’s only all-payer hospital rate regulation system—is broadening in scope to include outpatient services starting Jan. 1. The expanded program could impact independent medical laboratories, according to the Maryland Hospital Association (MHA). The Centers for Medicare and Medicaid Services (CMS) and...

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