Tag: #healthinsurance

Posted in In The Know Series, Insurance, Training

EmblemHealth Plans that DO NOT require a REFERRAL-2019

Posted on by KR2Medical Billing

The following is the list of all the EmblemHealh Plans for 2019 that do not require a referral from their primary to see a specialist.

Commercial Plans:

Access I/II, EmblemHealth Platinum Choice, EmblemHealth Gold Choice, EmblemHealth Silver Choice, EmblemHelath Gold Premier 1, EmblemHealth Silver Plus1, EmblemHealth Silver Premier, EmblemHealth Platinum Premier, EmblemHealth Gold Premier, EmblemHealth EPO Value, EmblemHealth EPO Value HDHP

Medicare Advantage Plans:

EmblemHealth VIP  Go (HMO-POS) plans, EmblemHealth Affinity Medicare Passport Essentials (HMO), EmblemHealth Affinitiy Medicare Passport Essentials NYC (HMO), EmblemHealth Affinity Medicare Utimate (HMO SNP), and EmblemHealth Affinity Medicare Solutions (HMO SNP)

Remember if the EmblemHealth HIP plan has a Montefiore Logo and you are going to the provider associated with Montefiore you still also DO NOT Require a referral to see that specialist.

Posted in In The Know Series, Insurance, Payers and CPT reinbursement, Training

CMS and E/M code reimbursement rate effective 01/01/2018 (if approved)

Posted on by KR2Medical Billing

If approved: effective 01/01/2018 the following rates will apply to the E/M codes*: These are the proposed payments from CMS for providers that bill for Medicare patients. The documentation guidelines 1995 and 1995  will still apply towards inpatient Hospital visits and Commercial payers.

HCPCS code Current non-facility payment rate Proposed non-facility payment rate
HCPCS code: 99201 Current non-facility payment rate: $45 Proposed non-facility payment rate: $44
HCPCS code: 99202 Current non-facility payment rate: $76 Proposed non-facility payment rate: $135
HCPCS code: 99203 Current nonfacility payment rate: $110 Proposed nonfacility payment rate: $135
HCPCS code: 99204 Current nonfacility payment rate: $167 Proposed nonfacility payment rate: $135
HCPCS code: 99205 Current nonfacility payment rate: $211 Proposed nonfacility payment rate: $135
HCPCS code Current nonfacility payment rate Proposed nonfacility payment rate
HCPCS code: 99211 Current nonfacility payment rate: $22 Proposed nonfacility payment rate: $24
HCPCS code: 99212 Current nonfacility payment rate: $45 Proposed nonfacility payment rate: $93
HCPCS code: 99213 Current nonfacility payment rate: $74 Proposed nonfacility payment rate: $93
HCPCS code: 99214 Current nonfacility payment rate: $109 Proposed nonfacility payment rate: $93
HCPCS code: 99215 Current nonfacility payment rate: $148 Proposed nonfacility payment rate: $93