Recently, Cigna announced it will longer going to pay for the professional component of clinical pathology (PCCP) beginning July 11. This comes as no surprise; we have seen this coming for the past few years as UnitedHealthcare, Humana and Aetna have made similar moves.
Cigna, one of the last remaining payers that reimburses for the professional component of clinical pathology, will look to officially end that practice this summer, according to an update posted April 12.
As the U.S. continues to ramp up its efforts to administer Covid-19 vaccines, many providers have been inquiring about the process for becoming eligible to compliantly bill for vaccines.
With that in mind, the Vachette team has put together a helpful FAQ that covers Medicare payments, how to become a Mass Immunizer, compliant roster billing and more. The full document (PDF) may be downloaded below.
As part of the COVID relief and and appropriations package signed into effect Dec. 27, Congress took steps to mitigate significant fee schedule reductions for several specialties that were designed to offset payment boosts for evaluation and management (E/M) services.
CMS now appears to be tightening the reins on spending with new rules ostensibly designed to prevent fraud and abuse – and you can bet commercial payers will soon gladly follow suit.
As of Oct. 1, MOLDX has updated their LCDs/Billing and Coding Articles for the Multiplex Nucleic Amplified Tests for Respiratory Panels to no longer cover the PLA codes 0098-0099U, U100U, and 0115U. These PLA codes represent respiratory panels using BioFire® or GenMark® platforms.
Upon having conversations with our clients and colleagues in both the Noridian and Palmetto MACs, it has come to our attention that there is confusion in regards to reimbursement as it pertains to mutliplex NAATs for Respiratory Viral Panels.
Several clients recently informed us UnitedHealthcare (UHC) has issued refund requests to recover 88305 payments for prostate biopsies performed on Medicare Advantage members throughout the past six months.
At a time when patients and providers alike are being severely impacted by the COVID-19 Public Health Emergency, UnitedHealthcare (UHC) has taken the opportunity to push some aggressive policy changes to limit care -- all while reaping record profits.
Strong clinical pathology service is the foundation of a good health system relationship. This is the premise on which Tony Kubat, M.D., the President of Michigan Pathology Specialists, leads his 26-person pathology group in working with Spectrum Health System in Western Michigan.
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