Billing News Aug 2019



Lynch Syndrome Mutation Study Suggests Changes to Clinical Management

  • August 5, 2019

Based on a prospective observation of more than 6,000 individuals with the gene mutations associated with Lynch syndrome, investigators have suggested that management guidelines for the condition may need to be revised based on evidence of different gene and gender-specific risks and a relatively good prognosis for the most commonly associated...

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Medicare Plans to Modernize Payment Grouping and Code Editor Software

  • August 5, 2019

The Centers for Medicare & Medicaid Services (CMS) is modernizing its grouping and code editor software. Medicare processes all Original Medicare institutional claims through one of three sub-systems within the Fiscal Intermediary Shared System (FISS): • The Medicare Code Editor (MCE) • The Inpatient Grouper (MS-DRG) • The Integrated...

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New Waived Tests Under CLIA

  • August 5, 2019

Listed below are the latest tests approved by the Food and Drug Administration (FDA) as waived tests under CLIA. The Current Procedural Terminology (CPT) codes for the following new tests must have the modifier QW to be recognized as a waived test. However, CPT codes: 81002, 81025, 82270, 82272, 82962, 83026, 84830, 85013, and 85651 do not require...

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Interpace Diagnostics, SelectHealth Sign Patient Coverage Agreement for Thyroid Cancer Tests

  • August 5, 2019

Interpace Diagnostics announced that it has signed an agreement with SelectHealth/Intermountain Healthcare to offer its thyroid cancer detection assays to SelectHealth's members in Utah and Idaho.  In addition, Interpace said it will act as an in-network laboratory for these services to SelectHealth's members.

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Medi-Cal Update - Radiology Reimbursement Rate Adjustment

  • August 5, 2019

Effective retroactively for dates of service on or after April 1, 2017, the reimbursement rates for radiology services are adjusted. The rates adjustment will be implemented on July 22, 2019, but will not appear on the Med-Cal rates website until August 15, 2019. An Erroneous Payment Correction (EPC) will be implemented to reprocess affected...

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House Lawmakers Add Arbitration to Surprise Billing Measure

  • August 5, 2019

A House of Representatives panel passed legislation to address surprise medical bills that includes a last-minute compromise to install an arbitration process, handing healthcare providers a major win. The House Energy and Commerce Committee unanimously advanced the No Surprises Act as part of a major package that reauthorizes funding for...

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Interpace Dx Acquires Cancer Genetics Biopharma Services

  • August 5, 2019

In a conference call with investors and analysts Tuesday morning, Interpace CEO Jack Stover noted that the acquisition will both improve the firm's diagnostic business and expand its commercial offerings. "If you look at our biomarker capabilities, our products, and our current commercial capabilities in that space, [the acquisition] fits very...

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BCBS Medical Review – Policy Updates

  • August 5, 2019

Recent Policy Updates – Posted 7/17/2019 Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer In Coding section:  Added CPT code: 0045U. Deleted termed CPT code: 0008M. (Effective January 1, 2018.) Identification of Microorganisms Using Nucleic Acid Testing In the...

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