Month: July 2021

Posted in BCBS Empire NY, Training, Updates

BCBS NY Medicaid: New Policy-Pass-through and Outside Laboratory billing

Posted on by KR2Medical Billing

This reimbursement policy applies to Empire BCBS Health Plus members. The new reimbursement policy will become effective for DOS on 10/01/2021 and thereafter.

Empire BlueCross BlueShield HealthPlus does not allow pass-through billing for lab services. Claims appended with Modifier 90 and an office place of service will be denied unless provider, state, federal or CMS contracts and/or requirements indicate otherwise.

Reimbursement:

Empire BCBS HealthPlus will reimburse 100% of the applicable fee schedule or contracted/negotiated rate to the diagnostic laboratory that is performing the test.

Coding: Modifier 90-definition

Modifier 90 is used when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified healthcare professional. The procedure may be identified by adding Modifier 90 to the usual procedure number.

To read the complete reimbursement policy, please click here.

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Posted in BCBS Empire NY, Training, Updates

BCBS NY: Reimbursement Policies Updates for 2021

Posted on by KR2Medical Billing

1.Reimbursement Policy: Consultations (Professional)

Effective 10/31/2021- Empire BCBS policy “Documentation and Reporting Guidelines for Consultations” policy will be renamed as “Consultations” Please remember that this policy will be updated to align with CMS guidance- DOES NOT ALLOW reimbursement for inpatient (99251-99255) or outpatient (99241-99245) consultation codes and requires providers to bill the appropriate office visit Evaluation and Management (E&M) code for consultation services

To read this full reimbursement policy, please click here.

2. NEW Reimbursement Policy (facility): Non-patient Laboratory Services

Effective 10/01/2021- Empire BCBS will implement a new reimbursement policy- Non-Patient Laboratory Services. This policy states that Empire does not allow reimbursement for non-patient laboratory services when reported on a UB-04 with bill type 014X unless provider, state, federal or CMS and/or requirements indicate otherwise. 

To read this full reimbursement policy, please click here.

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Posted in #Medicareadvantage, #unitedhealthcare, Training, Updates

UHC: Payment for COVID-19 testing coverage, outpatient SNF

Posted on by KR2Medical Billing

Previously, UHC would not reimburse for COVID-19 testing when done outside of a skilled inpatient stay at a SNF.

However, during the PHE, starting Jan 27,2020 and then renewed on April 21,2021, subject to further extension, UHC is going to pay for the COVID-19 testing that is done outside of the skilled inpatient stay at a SNF.

This change applies to the following Medicare Advantage Plans:

  • Medicare Advantage Plans
  • Dual Eligible Special Needs Plans (DSNP)
  • Chronic Special Needs Plans (CSNP)
  • UnitedHealthcare Assisted Living Plans (IE-SNP)
  • FIDE/MMP Plans

Plans that this change DOES NOT APPLY TO:

  • UnitedHealthcare Nursing Home Plans (ISNP)
  • UnitedHealthcare commercial plans
  • UnitedHealthcare Community Plans (Medicaid Only Plans)

UHC will re-process the claims, there is no further action needed.

UHC will reprocess claims previously paid at $0 to be reimbursed at 100% of the Medicare fee schedule. No action is required from affected SNFs for these adjustments.

The following codes are going be reimbursed at 100% of Medicare Fee Schedule:

Reminder!

COVID-19 testing performed during an approved skilled stay are subject to Centers for Medicare and Medicaid Services (CMS) consolidated billing rules and are not separately reimbursable, except for the UnitedHealthcare Nursing Home Plan (ISNP). New applicable CMS covered COVID-19 testing codes may be added periodically. We may add or remove codes from the following list, in accordance with CMS coverage guidelines.

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