Laureen shows you her proprietary “Bubbling and Highlighting Technique”
Download your Free copy of my "Medical Coding From Home Ebook" at the top right corner of this page 2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers Click here for more sample CPC practice exam questions and answers with full rationaleTag Archives: Changes
Upcoming HCPCS (NEW) Code Changes Effective from October 1, 2019
New Codes:
Upcoming CPT (DELETED) Code Changes Effective from October 1, 2019
Deleted Codes:
0104U Hereditary pan cancer (eg, hereditary breast and ovarian cancer, hereditary endometrial cancer, hereditary colorectal cancer), genomic sequence analysis panel utilizing a combination of NGS, Sanger, MLPA, and array CGH, with MRNA analytics to resolve variants of unknown significance when indicated (32 genes[sequencing and deletion/duplication], EPCAM and GREM1 [deletion/duplication only])
Upcoming CPT (NEW) Code Changes Effective from October 1, 2019
New Codes:
See Deleted Codes
Changes in Allergy Testing guidelines for Horizon BCBSNJ effective from September 10, 2019
Effective September 10, 2019, Horizon BCBSN will change the way consider certain professional claims for services provided to Horizon BCBSNJ Medicare Advantage (MA) members based on an update to our medical policy, Allergy Testing.
Based on the submitted diagnosis code(s), claims submitted for services provided on and after September 10, 2019 to patients enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans will be processed as follows.
The services represented by CPT code 86003 may be denied as not medically necessary.
Information may be requested to help us determine the medical appropriateness of the services represented by CPT code 86003. Following our review of medical record information, these services may be denied as not medically necessary.
Source: https://www.horizonblue.com/providers/news/news-legal-notices/medical-policy-update-allergy-testing-0
Changes in Reimbursement Guidelines for Behavioral Health services
Horizon BCBSNJ Reimbursement Guidelines Changes in Outpatient Laboratory Claims
Outpatient Laboratory Claims: Referring Practitioner Required
In accordance with Centers for Medicare and Medicaid Services (CMS) guidelines, Horizon BCBSNJ requires that claims for clinical laboratory services report the referring practitioner on the claim submission. This applies to participating and non-participating providers.
Effective November 15, 2019 Horizon BCBSNJ will change the way consider and reimburse certain clinical laboratory claims that do not include information about the referring practitioner information.
Based on the guidelines of this reimbursement policy, Horizon BCBSNJ will deny outpatient claims submitted by participating or nonparticipating clinical laboratories for services provided on and after November 15, 2019 if the referring practitioner information is not included.
To avoid claim outpatient clinical laboratory claim denials, include referring practitioner information as noted below,
- In 837P transactions please include referring practitioner information in Loop 2310A
- On CMS 1500 claim forms (per the Medicare Claims Processing Manual Chapter 26 – Completing and Processing Form CMS-1500 Data Set), please include the following referring practitioner information
- Field 17. Enter a “DN” qualifier (to denote Referring Provider), and Enter the referring provider name
- Field 17b. Enter the NPI of the referring provider
To address claims denied for no referring practitioner information, clinical laboratories will have to submit a corrected claim that includes this required information. Until such time as this corrected claim information can be submitted and processed, members cannot be held liable for services related to these claim denials.
Source: https://www.horizonblue.com/providers/news/news-legal-notices/reimbursement-policy-implementation-outpatient-laboratory-claims-referring-practitioner-required
Keep on Top of Rapid COVID-19 Funding Changes
Complex coronavirus funding gets even more confusing by the day. If you’re just getting a handle on the three main sources of funding for COVID-19’s impact, get ready for a whole new layer of complications. CARES Act Provider Relief Fund The U.S. Department of Health and Human Services (HHS) is releasing $ 20 billion more in […]
The post Keep on Top of Rapid COVID-19 Funding Changes appeared first on AAPC Knowledge Center.
CMS Announces Changes to Payment Programs
The Centers for Medicare & Medicaid Services (CMS) recently announced that it is reevaluating the amounts that will be paid under its Accelerated Payment Program and suspending its Advance Payment Program to Part B suppliers effective immediately. After a payout of $ 100 billion to healthcare providers and in light of the $ 175 billion recently appropriated […]
The post CMS Announces Changes to Payment Programs appeared first on AAPC Knowledge Center.
COVID-19 Brings Big Changes to Home Health
CARES Act, Medicare interim final rule change who can order home health, homebound definition, and much more. Congress and the Centers for Medicare & Medicaid Services (CMS) have gone into overdrive to provide home care providers with regulatory relief to fight the COVID-19 pandemic. The Coronavirus Aid, Relief, and Economic Security (CARES) Act, signed into […]
The post COVID-19 Brings Big Changes to Home Health appeared first on AAPC Knowledge Center.