Billing News Jan 2022



Aetna - New Pre-approval Requirements for Alabama, Arkansas, Louisiana and Mississippi Commercial Members

  • January 6, 2022

Our Enhanced Clinical Review program with eviCore healthcare will require pre-approval for certain procedures. The program will start on November 1, 2021. It affects Alabama, Arkansas, Louisiana, and Mississippi members in our fully insured and self-insured commercial HMO/PPO Aetna® products. Services that require pre-approval: High-tech...

Read



FDA Unveils Draft Guidance for SARS-CoV-2 Test Developers to Gain Full Regulatory Approval

  • January 6, 2022

The US Food and Drug Administration has released draft guidance for medical device manufacturers, including SARS-CoV-2 test developers, on how to transition from Emergency Use Authorization to full marketing and regulatory approval. Although the FDA has not yet set an expiration date for EUAs, once it comes developers will not be able to...

Read



2022 Pathology Quality Measures

  • January 6, 2022

The Pathologists Quality Registry offers 15 quality measures. Six are Merit-based Incentive Payment System (MIPS) clinical quality measures (CQMs). The remaining 9 are specific pathology measures, all developed by the CAP and approved by the CMS as qualified clinical data registry (QCDR) measures—exclusively available in the Pathologists Quality...

Read



FDA Proposes 180-Day Transition before Terminating COVID-19 EUAS, Enforcement Policies

  • January 6, 2022

The US Food and Drug Administration (FDA) is proposing to give medical device makers 180-days’ notice before terminating emergency use authorizations (EUAs) and phasing out its enforcement policies for medical devices issued during the COVID-19 public health emergency (PHE). The transition plan comes in the form of two draft guidances issued in...

Read



UHC – Medicare Advantage - Molecular Pathology Policy, Professional and Facility

  • January 6, 2022

Effective Date February 1st, 2022 Revision of the Overview section with additional details regarding the MolDX Program. Updated the Reimbursement Guidelines section with additional details relative to obtaining and reporting unique identifiers for molecular diagnostic tests. Added Definitions and Questions and Answer sections.

Read



Noninvasive Techniques for the Evaluation and Monitoring of Patients with Chronic Liver Disease

  • January 6, 2022

Medical Policy update: 01-04-2022 Updated Description Section, Updated Rationale Section, Updated Codes Section Added: 0014M, 0166U Deleted Codes:84999

Read



BCBS - Molecular Markers in Fine Needle Aspiration of the Thyroid

  • January 6, 2022

Medical Policy update: 01-03-2022 In coding section Added CPT 0287T

Read



BCBS - Federal No Surprises Act Prohibits ‘Surprise Billing’

  • January 6, 2022

Blue Cross Blue Shield of Michigan and Blue Care Network have made changes to align with the federal No Surprises Act, effective Jan. 1, 2022. The law, part of the Consolidated Appropriations Act, or CAA, prohibits surprise billing nationwide for emergency, some non-emergency and air ambulance services.  Surprise billing is when a member...

Read