Billing News Mar 2019



Medicare, Medicaid Spending Per Enrollee Slower Than Private Plans

  • March 5, 2019

Medicare and Medicaid spending saw significantly slower growth per enrollee than private payer expenditures over the last decade, a new report from the Urban Institute shows. The public payers may have experienced the fastest rate of spending growth from 2006 to 2017. But enrollment is largely to blame for the rise in Medicare and Medicaid...

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Regulators Look to Increase Interoperability and Patient Access to Health Data

  • March 5, 2019

CMS' Proposal: Interoperability and Patient Access Proposed Rule CMS released the Interoperability and Patient Access Proposed Rule on February 11th. This proposal aims to increase the level of access that patients have to the information they need to make informed, responsible health care decisions, including data about prices,...

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NHGRI Earmarks $7.3M for Human Genome Reference Program Projects

  • March 5, 2019

The National Human Genome Research Institute has earmarked nearly $7.3 million to fund a series of research projects over the next several years to advance its recently established Human Genome Reference Program (HGRP), which aims to build a human genome reference that better accounts for genetic diversity than the existing reference. In early...

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New Family PACT Benefit for HPV Genotyping

  • March 5, 2019

Effective for dates of service on or after December 1, 2018, CPT code 87625 (infectious agent detection by nucleic acid [DNA or RNA]; Human Papillomavirus [HPV], types 16 and 18 only, includes type 45, if performed) is a new Family Planning, Access, Care and Treatment (Family PACT) Program benefit. CPT code 87625 is reimbursable with modifier 33...

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CPT 87150 Reimbursement Change

  • March 5, 2019

Effective February 15, 2019, the Oklahoma Health Care Authority (OHCA) will only reimburse for CPT 87150 (culture typing; identification by nucleic acid [DNA or RNA] probe, amplified probe technique, per culture or isolate, each organism probed) in the outpatient hospital setting.  Please note: When this service is performed in the inpatient...

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Clinical Laboratory Improvement Amendments of 1988 (CLIA) Proficiency Testing Regulations Related to Analytes and Acceptable Performance

  • March 5, 2019

On February 1, 2019, the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) issued a Notice of Proposed Rulemaking [CMS-3355-P].  This notice of proposed rulemaking includes the addition and deletion of analytes requiring proficiency testing and updates criteria for acceptable...

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Independent Laboratory Billing of Laboratory Tests for End-Stage Renal Disease (ESRD) Beneficiaries and the Sunset of the CB Modifier CR11061 Feb 05, 2019

  • March 5, 2019

Independent Laboratory Billing of Laboratory Tests for End-Stage Renal Disease (ESRD) Beneficiaries and the Sunset of the CB Modifier. MLN Matters Number: MM11061 Related CR Release Date: February 1, 2019 Related CR Transmittal Number: R4227CP Related Change Request (CR) Number: 11061 Effective Date: July 1, 2019 Implementation Date: July 1, 2019...

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CMS Office of the Actuary Releases 2018-2027 Projections of National Health Expenditures

  • March 5, 2019

National health expenditure growth is expected to average 5.5 percent annually from 2018-2027, reaching nearly $6.0 trillion by 2027, according to a report published today by the independent Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS).  Similar to the findings in last year’s report, the report found that...

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