Billing News May 2019



Cigna Coverage and Policy Updates May 2019 Flow Cytometry and Pass Through Bills

  • May 20, 2019

After a recent review in coverage, reimbursement, and administrative policies, Cigna has published several changes that will go live starting this week. Two of these updates will directly impact pathology practices and laboratories: Flow Cytometry Policy Update Claims with dates of service on or after May 20, 2019 will be subject to review...

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HHS Implements HIPAA Fine Caps Based on Level of Culpability

  • May 3, 2019

Fines for HIPAA violations in which the affected party had no knowledge of nor culpability in the privacy breach will now be capped at $25,000, a fraction of the previous $1.5 million limit, according to a new notice of enforcement discretion from the HHS. The update, issued on April 26, is not an amendment to HIPAA, but merely a new...

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HHS Moves to Reduce HIPAA Fines, Lowering the Cap More than $1M for Some Violations

  • May 3, 2019

The Department of Health and Human Services (HHS) adjusted the monetary penalties it imposes on healthcare providers, health plans and their business associates for violating the Health Insurance Portability and Accountability Act (HIPAA), lowering the annual cap for the least-severe violation from $1.5 million to $25,000. HHS said the new tier...

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Changes to the Timely Filing for Adjustments & Corrected Claims Administrative Policy

  • May 3, 2019

Effective July 1, 2019 there will be a change to the Timely Filing for Adjustments & Corrected Claims Administrative Policy timeframe. We will be moving from 18 months to 12 months for corrected claims.  You can view the updated administrative policy by visiting anthem.com/provider. Select ‘Find Resources in Your State’ and select New...

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Reimbursement Policy Update: Drug Screen Testing (Professional)

  • May 3, 2019

Beginning with dates of service on or after April 28, 2019, Anthem policy language will be updated to allow the lower level definitive code drug testing of 1-7 drug class(es) (G0480) on the same day as presumptive services. Additionally, the definitive drug testing related coding section was expanded for clarification. For more information about...

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Future Local Coverage Determination (LCD): myPath Melanoma Assay

  • May 3, 2019

New MolDX Policy: CGS Administrators has a new MolDx policy that will take effect on June 3, 2019, MolDX: myPath Melanoma Assay L37907. This policy is currently in notice period and all comments received are in the response to comments article that is attached to the policy.

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Medical Policies Updates April 24, 2019

  • May 3, 2019

Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes Genetic Testing for Marfan Syndrome, Thoracic Aortic Aneurysms and Dissections, and Related   Disorders Genetic Testing for Predisposition to Inherited Hypertrophic Cardiomyopathy Serum Tumor Markers for Breast Malignancies

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The Eyes (And Privacy Laws) Of Texas Are Upon You…

  • May 3, 2019

Texas legislature has introduced not one, but two separate bills relating to the privacy of personal information. Although still in their nascent stages, both bills are following California’s lead in creating enhanced and stringent privacy protections for individual consumers. In terms of who must comply with the law, the TPPA would only apply to...

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