Billing News Oct 2022
BCBS Michigan - Genetic testing for inherited hypertrophic cardiomyopathy
New Payable Procedure: 81439 - Genetic testing for inherited hypertrophic cardiomyopathy The safety and effectiveness of genetic testing for inherited hypertrophic cardiomyopathy have been established. It may be considered a useful diagnostic and prognostic option for patients meeting patient selection criteria. Payment policy: It isn’t...
AMA, AHA move to dismiss surprise billing rule lawsuit but hint at future moves
The American Hospital Association and American Medical Association dismissed their lawsuit challenging the Biden administration’s surprise billing rule but cautioned more litigation could be on the way. The two medical advocacy groups announced in a legal filing on Tuesday that the lawsuit challenging the rule was moot after a new final...
Texas physician 'gold card' rules take effect Oct. 1
Physicians and providers in Texas will begin seeing the effects of the state's "gold card" law Oct. 1. Under the law, physicians who have a 90 percent prior authorization approval rate over a six-month period on certain services are exempt from prior authorization requirements for those services. Gold cards are granted per plan, per...
FDA wants COVID test developers to shift from EUAs to traditional premarket pathways
The US Food and Drug Administration (FDA) has released updated guidance on COVID-19 diagnostic and serology testing, signaling its intention to review fewer emergency use authorizations (EUAs) for new tests moving forward.
Experts Sound Alarm on Ruling Threatening Preventive Cancer Care
More than two dozen patient advocacy organizations have raised alarms about a recent court ruling that could threaten patient access to no-cost preventive screenings, including cancer screenings. In a statement, the groups highlighted that the decision "would result in a return to financial and other barriers proven to discourage Americans...
District Court ruling in Texas calls ACA preventive care requirement ‘unconstitutional’
In a ruling that threatens some aspects of preventive care coverage under the Affordable Care Act, a District Court judge in Texas struck down a provision requiring insurers to fully cover preventive services with an “A” or “B” rating under current recommendations from the U.S. Preventive Services Task Force (USPSTF). ...
Pharmacies urge Biden to keep COVID emergency powers in place
Pharmacies are lobbying the Biden administration to keep emergency provisions enacted under COVID-19 intact for a while longer. The National Association of Chain Drug Stores (NACDS) wants the White House to keep the Public Readiness and Emergency Preparedness (PREP) Act in place until October 2024. PREP provides liability protection to...
Universal Genetic Testing in Breast Cancer Further Supported in New Invitae-Led Study
NCCN has since updated its guidelines to additionally recommend genetic testing of patients with triple-negative breast cancer; for PARP inhibitor treatment eligibility in metastatic disease for high-risk patients with ERBB2-negative disease; and if a patient has a greater than 5 percent chance of a BRCA1 or BRCA2 variant based on an assessment...
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