Insurance Updates Centers for Medicaid and Medicare Services (CMS) CMS updated and released a draft of the National Coverage Determinations (NCD) Guidelines for the Alzheimer’s disease treatment drug, Aduhelm. The coverage limitations could create challenges for those seeking treatment. The NCD process began in July of 2021 and at the time, the drug was highly […]
March Bulletin – CMS Announces New Place of Service Code
CMS Announces New Place of Service Code Effective January 1, 2022, a new place of service (POS) code became effective for use. The new POS Code, 10, indicates Telehealth services provided in the patient’s home. Prior to the creation of POS 10, the correct place of service code for all Telehealth visits was 2. Now, […]
March Bulletin – Insurance Company Updates
Insurance Company Updates Several insurance companies have made note-worthy updates to their billing policies. Superior HealthPlan Effective June 1, 2022, the criteria for the assessment and treatment of Attention Deficit Hyperactivity Disorder (ADHD) has been revised and updated. More than a dozen CPT codes have been deemed not medically necessary when billed with a sole […]
February Bulletin – The “No Surprise Act” Causes Confusion
Since the No Surprise Act (NSA) became effective on January 1, 2022, medical offices are experiencing trouble understanding and implanting the new requirements to remain compliant with the NSA guidelines. On January 20, 2022, the Medical Group Management Association (MGMA) called on the Centers for Medicare and Medicaid Services (CMS) and the US Department of […]
February Bulletin – Stay Up-To-Date on COVID-19 Vaccine Coding
COVID-19 vaccines have been available for more than a year and with boosters being approved and recommended, it is easy to bill with an incorrect vaccine or administration code. Below are the most used COVID-19 vaccination codes: CPT/HCPCS Description CPT/HCPCS Code Vaccine/Procedure Name SARSCOV2 VAC 30MCG/0.3ML IM 91300 Pfizer-BioNTech COVID-19 Vaccine ADM SARSCOV2 30MCG/0.3ML 1ST […]
January Bulletin – COVID-19 Updates
CMS Now Requiring Payers to Cover At-Home Testing Effective January 15, 2022, patients with a health insurance plan can go online or to a pharmacy and purchase at-home COVID-19 tests at no cost. This will happen through reimbursement or free of charges through insurance. If a patient is required to pay for a test […]
January Bulletin – Billing Reminders for the New Year
Billing Reminders for the New Year Eligibility & Benefits With a new year comes new insurance policies for patients across the nation. It is important to remember that many plans change at the start of a new year so verifying benefits and eligibility is key to proper billing. While some patients keep the same insurance […]
December Bulletin – COVID-19 Updates
COVID-19 Updates Omicron Variant: What to Know On November 24, a new variant of the COVID-19 virus was reported to the World Health Organization (WHO). Two days later on November 26, the WHO classified the Omicron Variant as a “Variant of Concern.” The first detected cases were found in Botswana and South Africa and have […]
December Bulletin – CMS Billing Updates for 2022
CMS Billing Updates for 2022 Premiums, Deductibles & Coinsurance Changes In November, the Centers for Medicare & Medicaid Services (CMS) released the 2022 premiums, deductibles and coinsurance amounts for Medicare Part A and Part B. Each year to determine the Medicare Part B premiums, deductibles and coinsurance amounts, the Social Security Act is used and […]
October Bulletin – COVID-19 Vaccine Updates
COVID-19 Vaccine Updates Vaccines for Children In late September, Pfizer announced that the Phase 2/3 trial for children 5 to 11 showed that their COVID-19 vaccine was safe and generated a “robust” antibody response. The trial included more than 2.200 participants and used a two-dose regimen of the vaccine administered three weeks apart. This trial […]