Billing News Dec 2020



Special Fraud Alert: OIG Raises Concerns with Speaker Programs

  • December 7, 2020

In its November 16, 2020, Special Fraud Alert, the HHS Office of Inspector General drew attention to potential fraud and abuse risks of speaker programs hosted by pharmaceutical companies and medical device manufacturers. Companies should evaluate their speaker programs in light of this new guidance and determine whether adjustments should be made...

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Hospitals Need to Post Their Negotiated Prices in Less Than Six Short Weeks

  • December 7, 2020

Barring an appeals court decision overturning the rule, the mandate goes into effect on January 1, 2021. The final rule will require hospitals to make their standard charges public in two ways beginning in 2021: First, they must be available in a comprehensive machine-readable file. Hospitals will be required to make public all hospital standard...

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Upcoming MIPS Important Dates and Deadlines

  • December 7, 2020

The Centers for Medicare & Medicaid Services (CMS) would like to remind clinicians of important upcoming Merit-based Incentive Payment System (MIPS) dates and deadlines: December 31 – 2020 Promoting Interoperability Hardship Exception Application period closes. Clinicians, groups, and virtual groups who believe they are eligible for this...

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White House Finalizes Overhauls of Stark, Anti-kickback Statutes

  • December 7, 2020

The final rules lower the level of downside risk necessary to qualify for the new safe harbors, in response to concerns from providers. The regs also include a provision that would allow hospitals to share cybersecurity tools with providers that have fewer resources, a much-requested addition. An example of the updated regulations in...

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In Shift, FDA Ordered to Provide 'Timely' EUA Reviews for COVID-19 Lab Developed Tests

  • December 7, 2020

HHS Assistant Secretary for Health and White House coronavirus testing czar Brett Giroir on Monday directed the FDA to review emergency use authorization requests for COVID-19 laboratory developed tests "in a timely manner," effectively reversing an FDA decision last month to no longer accept voluntary EUA applications for LDTs. ...

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Provider Requirement to Post Cash Price of COVID-19 Diagnostic Testing Pursuant to CARES Act & Potential to Incur Civil Monetary Penalties

  • December 7, 2020

November 2, 2020, HHS issued additional regulations to clarify the scope of this provision of the CARES Act. Specifically, HHS has indicated that “each provider of a COVID-19 diagnostic test that has a website make public the cash price information…and that the information itself, or a link to a web page that contains such information, must appear...

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Cigna Coronavirus (COVID-19) Interim Billing Guidance for Providers for Commercial Customers

  • December 7, 2020

As the COVID-19 pandemic continues, we appreciate that providers across the country are on the front line to offer dedicated care to our customers and help protect local communities. As federal guidelines continue to evolve in support of the COVID-19 pandemic, we have again extended our interim coverage accommodations for commercial Cigna medical...

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Clarification of COVID-19 Testing

  • December 7, 2020

As students head back to school and employees move back into offices, Blue Cross and Blue Shield of Kansas is clarifying our coverage of COVID-19 testing. BCBSKS will continue to cover the cost of, with no charge to the member, diagnostic testing services which: Meet primary coverage criteria for COVID-19 as defined by the CDC and CMS public...

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