Tag: #bcbsNY

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 BCBS Empire NY, Training, Updates

BCBS (NY): Proper coding for INR In-home patient monitoring

Posted on by KR2Medical Billing

This following policy is part of BCBS (NY) administrative policy guidelines (07/01/2021)

This blog post is for providers that need to meet the INR (in-home) monitoring quality measure.

What you will learn?

  1. What is INR monitoring Quality measure?
  2. Proper coding for in-home INR monitoring
  3. Documentation requirements to meet the INR in home monitoring measure

What is INR (International normalized ratio)?:

International normalized ratio (INR) is blood-clotting test. It is a test used to measure how quickly your blood forms a clot, compared with normal clotting time.

Background:

International normalized ratio is part of the 2021 Quality Measure Set (Pharmacy Quality Alliance (PQA) measures.

The QRS measure set is comprised of clinical quality measures, including the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) measures and Pharmacy Quality Alliance (PQA) measures.

Previously, patients taking warfarin (brand name Coumadin) were heading off to the lab or clinic every few weeks for an international normalized ratio (INR) blood test. However, currently there is a small, portable device that patients on warfarin, can now self-test with a finger prick drop of blood.

Is there a provider type restriction for this quality Measure?

No, there is not provider type restriction.

As a provider, which proper codes should I use for INR in-home patient monitoring?

Below please see the proper codes that providers should use for INR in-home patient monitoring.

Meeting INR monitoring Quality Measure:

Definition: The percentage of members 18 years of age and older who had at least one 56-day interval of warfarin therapy and who received at least one international normalized ratio (INR) monitoring test during each 56-day interval with active warfarin therapy.

INR quality measure requirements.

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