Billing News Jan 2021



Anthem: Important COVID-19 Update: Prior Authorization and Other Policy Adjustments (Updated December 22, 2020)

  • January 11, 2021

Laboratory tests for COVID-19 at both in-network and out-of-network laboratories will be covered with no cost sharing for members. Claims audits, retrospective review, peer to peer review and policy changes Anthem will adjust the way we handle and monitor claims to ease administrative demands on providers: Hospital Claims audits requiring...

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Newly Enacted End of Year Legislation Has Impact on Healthcare Providers

  • January 11, 2021

On December 27, President Trump signed into law the Consolidated Appropriations Act, 2021 (Act), which was passed by Congress the evening of December 21, after weeks of negotiation. The lengthy legislation, totaling in at 5,593 pages, provides for over $2.3 trillion in funding, $900 billion of which is allocated for COVID-19 relief. The Act...

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CMS Creates Direct Contracting Model to Serve Individuals Dually Eligible for Medicare and Medicaid

  • January 11, 2021

The Center for Medicare and Medicaid Innovation has created a new direct contracting model to enable Medicaid Managed Care Organizations to better serve enrollees who are dually eligible for Medicare and Medicaid. The innovation center created a new type of direct contracting entity that allows Medicaid MCOs to participate in the global and...

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Changes to HIPAA Privacy Rules on the Horizon

  • January 11, 2021

The press release issued by HHS on December 10, 2020, states its intention to empower patients, improve coordinated care, and reduce regulatory burdens in the health care industry. HHS notes that the medical crises brought on by the opioid and COVID-19 epidemics have heightened the need to make these updates. While many of the changes directly...

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Sprint to Coordinated Care AKS Safe Harbors and Stark Exceptions Finalized

  • January 11, 2021

On December 2, 2020, the Department of Health and Human Services (HHS), the Office of Inspector General (OIG) and the Center for Medicare and Medicaid Services (CMS) will jointly publish the final regulations first proposed on October 17, 2019: 1.     AKS Safe Harbors: https://public-inspection.federalregister.gov/2020-26072....

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Reimbursement Policy Effective January 1, 2021: Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005)

  • January 11, 2021

Add-on Payment for COVID-19 Diagnostic Testing Run on High Throughput Technology (U0005), will be effective January 1, 2021. This policy aligns with the Centers for Medicare & Medicaid Services’ approach. Effective January 1, 2021, and throughout the period of the COVID-19 public health emergency as declared by the Governor of New Jersey...

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Anthem Jan 1, 2021 Policy Updates / Medical Policy & Clinical Guidelines

  • January 11, 2021

The following Anthem Blue Cross and Blue Shield (Anthem) medical polices and clinical guidelines for Indiana, Kentucky, Missouri, Ohio and Wisconsin. NOTE *Precertification required Title Information Effective Date GENE.00055 Gene Expression Profiling for Risk Stratification of Inflammatory Bowel Disease (IBD) Severity...

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Genetic and Molecular Lab Testing Prior Authorization Expansion

  • January 11, 2021

Beginning April 1, 2021, UHC will require prior authorization/notification for additional CPT® codes for commercial members. https://www.uhcprovider.com/content/dam/provider/docs/public/resources/network-bulletin/genetic-molecular-lab-testing-cpt-codes-nb-appendix-jan-2021.pdf This is a part of the online prior authorization/...

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