Billing News Apr 2021



CMS Implements Automatic Exception Policy for Individual Clinicians in MIPS

  • April 13, 2021

CMS will implement an automatic extreme and uncontrollable circumstances policy for some clinicians participating in the Quality Payment Program's Merit-based Incentive Payment System.  The agency announced the automatic exception last week and said it was due to the COVID-19 public health emergency.  The exception only...

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FDA Posts Info on Impact of SARS-CoV-2 Mutations on Test Effectiveness

  • April 13, 2021

The US Food and Drug Administration on Tuesday published information for labs and health care providers detailing the impact of SARS-CoV-2 mutations on molecular, antigen, and serology tests for the virus. While the agency said that changes in the virus's genome may impact the effectiveness of antigen and serology tests, it noted in...

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Unique CPT Codes Approved For COVID-19 Immunizations

  • April 13, 2021

The CPT Editorial Panel has approved addition of 11 Category I codes (0001A, 0002A, 0011A, 0012A, 0021A, 0022A, 0031A, 91300, 91301, 91302, 91303), new and revised guidelines and parenthetical notes, and a new Appendix Q. These CPT codes, developed based on extensive collaboration with Centers for Medicare & Medicaid Services (CMS) and the...

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Highmark Has Completed Its Affiliation with HealthNow New York

  • April 13, 2021

Highmark has completed its affiliation with HealthNow New York, bringing its membership to more than 6 million and making it the country's fourth-largest Blues plan. Under the deal, HealthNow will be rebranded as Highmark Blue Cross Blue Shield of Western New York and Highmark Blue Cross Blue Shield of Northeastern New York. The New York insurer...

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New Provider Enrollment Administrative Action Authorities

  • April 13, 2021

Affiliation Disclosures Overview We believe these affiliation disclosure provisions will allow us to better track current and past relationships between and among different providers and suppliers. In addition, they will help us find and take action on affiliations among providers and suppliers posing an undue risk to Medicare, Medicaid, and the...

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Repayment of COVID-19 Accelerated and Advance Payments Began On March 30, 2021

  • April 13, 2021

This article informs all Medicare providers and suppliers who requested and received CAAPs that we began recovering those payments as early as March 30, 2021, depending upon the 1 year anniversary of when you received your first payment. If you received an accelerated or advance payment, CMS will begin to recoup any outstanding balance from any...

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Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens

  • April 13, 2021

This article informs you about the Calendar Year (CY) 2021 changes to travel allowances when billed: • On a per mileage basis using HCPCS code P9603 $1.01 • On a flat rate basis using HCPCS code P9604 $10.10 Per Mile Travel Allowance (P9603) – You should use the per mile travel allowance in situations where the average trip to the patients’...

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April 2021 Update of the Hospital Outpatient Prospective Payment System (OPPS)

  • April 13, 2021

Advanced Diagnostic Laboratory Tests (ADLT) Under the Clinical Lab Fee Schedule (CLFS) Under the OPPS, tests that receive ADLT status under Section 1834A(d)(5)(A) of the Social Security Act (the Act) are assigned to status indicator A (Not paid under OPPS. Paid by MACs under a fee schedule or payment system other than OPPS). In the October 2019...

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