Billing News Apr 2021



Cigna to Stop Reimbursement for Professional Component of Clinical Pathology Claims

  • April 15, 2021

On April 12, 2021 Cigna issued an update to their Modifier 26 Professional Component policy, stating codes inappropriately billed with the 26 modifier will be denied effective 7/11/2021. XIFIN interprets this to mean Cigna will discontinue reimbursing the Professional Component of Clinical Laboratory (PCCL) claims.  The reimbursement...

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Reimbursement Policy Update - Molecular Pathology Policy

  • April 13, 2021

In accordance with CMS guidelines UnitedHealthcare Medicare Advantage, will require Providers to submit claims with an appropriate unique test identifier associated with the Molecular Diagnostic Test Services provided.. This policy will apply to both Facility and Professional Claims. Professional Lab Services should fill out Loop 2400/ SV101-7 for...

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UHC – COVID-19 Billing Updates

  • April 13, 2021

Urgent care testing: Effective March 26, 2021, UnitedHealthcare will reimburse COVID-19 testing by urgent care facilities only when billed with a COVID-19 testing procedure code along with one of the appropriate Z codes. This applies to claims for Individual and Group Market health plans. Reimbursement will be 100% of the CMS allowable rate....

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Reimbursement Policy Update – Laboratory Services Respiratory Viral Panel Testing Policy, Facility

  • April 13, 2021

Effective June 1, 2021 The new Laboratory Services Respiratory Viral Panel Testing Policy, Facility will be effective for dates of service on or after 6/1/2021. Consistent with guidelines included in CMS Local Coverage Determinations, the policy will deny certain multiplex PCR respiratory viral panels of 6 or more pathogens.

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Reimbursement Policy Update – Laboratory Services Policy, Professional

  • April 13, 2021

Effective with dates of service on or after June 1, 2021, UnitedHealthcare will update the Laboratory Services Policy, Professional. The policy lab panel bundling criteria will require all individual component lab codes to be present, as set forth in CPT. A lab panel code should only be reported if all components of the lab panel are rendered....

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Labs Left Outside Value-Based Care Arrangements by Stark, Anti-Kickback Reforms

  • April 13, 2021

Recent changes to the federal Stark Law and Anti-Kickback Statute provide certain clarifications that could prove somewhat helpful to labs, but the reforms leave the industry on the outside looking in when it comes to participating in value-based care. Some observers suggest that this could hamper efforts within the laboratory business to better...

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Medicare Coverage Breakthrough Delayed

  • April 13, 2021

Biden Administration Delays Effective Date and Opens Another Comment Period for New Medicare Coverage Pathway for Breakthrough Medical Devices and Definition of “Reasonable and Necessary” CMS delayed the effective date of a groundbreaking Medicare coverage regulation issued in the final days of the Trump Administration. The Final Rule entitled, “...

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Special Edition - Temporary Claims Hold Pending Congressional Action to Extend 2% Sequester Reduction Suspension

  • April 13, 2021

In anticipation of possible Congressional action to extend the 2% sequester reduction suspension, we instructed the Medicare Administrative Contractors (MACs) to hold all claims with dates of service on or after April 1, 2021, for a short period without affecting providers’ cash flow. This will minimize the volume of claims the MACs must reprocess...

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