Latest News
2022 Covid-19 coding updates and revisions
The following updates and revisions for Covid-19-related codes became effective Oct. 1, 2021:
Cigna again moves to end PC clinical pathology payments
After holding off on the move during the summer amid significant pushback from pathology and lab advocates, Cigna appears to again be moving forward with its plan to end reimbursement for the professional component of clinical pathology (PC/CP) beginning Nov. 1, 2021.
Aetna to reduce timely filing limits for non-par providers in 2022
Aetna has announced timely filing limits for non-participating providers will be reduced from 27 months to 12 months for traditional medical claims beginning Jan. 1, 2022.
As Medicare enrollment approaches, ensure seniors in your life are prepared
Medicare open enrollment begins Oct. 15 and runs through Dec. 7. If you have elderly parents, aunts, uncles, or friends, talk to them about changes they want to make.
UHC Medicare Advantage claims to require DEX Z-code beginning Oct. 1
Given this news, now would be a great time to review your test compendium and payer mix. Are there any qualifying tests that need to be registered on the MolDX?
Case study: Utilizing the Covid-19 Coverage Assistance Fund
The Covid-19 Coverage Assistance Fund was created to cover the cost of administering the vaccine to patients whose insurance doesn't cover vaccination.
First Provider Relief Fund spending reports due Sept. 30
Health care providers who received distributions from the Health and Human Services Provider Relief Fund between April 1 and June 30, 2020, must submit their first report on use of those funds by Sept. 30, 2021.
Most private payers reinstate cost sharing for Covid hospitalizations
With Covid-19 vaccines now readily available, most private payers have moved to reinstate cost sharing for Covid-19-related hospitalizations and treatments.
As more labs perform Covid variant testing, will payors reimburse?
“This is not the same Covid as last year and there are treatment implications with each variant,” says Dr. William Budd. “The severity of the strain of Covid can vary. It is medically significant to know if your patient has an aggressive variant vs. a less aggressive variant.
As Covid re-emerges, it’s déjà vu all over again
In a recent conversation with one of our southern pathology groups, we are realizing it is May of 2020 again. Their hospital has shut down elective surgeries, they have very little surgical volume (about 15% of the norm) and things do not look good as they have 200 Covid-positive inpatients. In short, it’s back.
CMS to pay $40 for booster dose of Covid-19 vaccine
Last week, CMS announced Medicare will pay $40 for administering a booster dose of the Pfizer or Moderna Covid-19 vaccine to certain immunocompromised individuals, in accordance with the new FDA Emergency Use Authorization (EUA).
A new managed care strategy for pathologists
The time has come for a new mindset. No longer should pathology contracts be tied to a draconian Medicare fee schedule hurtling towards the lowest payment possible.
Medi-Cal rate methodology boosted under new law
California pathologists who have grown frustrated with retroactive recoupments from Medi-Cal in recent years due to their outdated rate-setting methodology now have some relief after California Gov. Gavin Newsom signed a comprehensive health care budget bill (AB 133) on July 27.
Final 2020 MIPS scores now available for review
oviders who participated in the 2020 MIPS Performance Period may now view their final scores. Participants also now have the option to request a targeted review if they believe any errors were made in calculating their bonus or penalty for the 2022 payment year.
Opinion: Is healthcare set to face a pandemic bubble?
In 2020 and early 2021, more than $4 trillion was pumped directly into society, including funding for healthcare providers and facilities. While most Americans spent last year wondering if the world was collapsing, healthcare had one of its best years ever.
Who's reviewing revenue strategy with you at this time?
Are you billing all the correct CPT codes? You’d be surprised at what you might be missing. We will review your Fee Schedule/Charge Master at no cost.
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