Tag: #medicalbilling

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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Posted in MVP (NY/VT) Insurance Payer, Training, Updates

MVP (NY/VT): COVID-19 Treatment and Virtual Care, Cost-Share Update

Posted on by KR2Medical Billing

Below policy will apply to MVP plans that are located in New York and Vermont.

New York Virtual Care Cost-Share: Telemedicine

For MVP Medicare Advantage Plans- MVP will continue to apply the cost sharing waver for audio/visual and audio only until the DOS (dates of service) Dec 31,2021.

For MVP Commercial Plans- Starting August 1,2021 and thereafter the patients will have to pay their “in-person visit” cost-share for audio/visual and audio only visits according to their plan details.

Vermont Virtual Care Cost-Share: Telemedicine

For MVP Medicare Advantage Plans- MVP will continue to apply the cost sharing waver for audio/visual and audio only until the DOS (dates of service) Dec 31,2021.

For MVP Commercial Plans- Starting August 1,2021 and thereafter the patients will have to pay their “in-person visit” cost-share for audio/visual and audio only visits according to their plan details.

New York Covid-19 Treatment member Cost-Share:

Effective August 1, 2021, MVP will no longer waive the cost-share for COVID-19 treatment.

***Vermont Covid-19 Treatment member Cost-Share: ***

MVP will continue to cover COVID-19 treatment in full until March 1, 2022 as is required by
Vermont Rules.

COVID-19 Testing Member Cost-Share: NY &VT

MVP will continue to cover COVID-19 testing in full in New York and Vermont

COVID -19 Testing Coding and Billing Corner:

As of January 1, 2021 claims billed with a diagnosis code Z03.818 in conjunction with a COVID19 testing procedure code will be denied

MVP will retain the expanded set of codes eligible for telehealth, consistent with CMS guidance, and will continue to monitor state and federal guidelines and regulations. In addition, MVP supports continued telehealth reimbursement and is currently reviewing coding guidance.

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Posted in MVP (NY/VT) Insurance Payer, Updates

MVP (NY Providers)-New Policy for : Robotic and Computer Assisted Surgery

Posted on by KR2Medical Billing

As of 06/01/2021, MVP will be changing Robotic and Computer Assisted Surgery from
medical policy to a payment policy.

MVP will no longer review Robotic and Computer Assisted Surgery as experimental/investigational.

MVP will not provide additional reimbursement based upon the type of instruments, techniques, or approach used in the surgical procedure.

MVP does not provide additional professional or technical reimbursement for use of robotic or
computer assisted instrumentation.

According to MVP reimbursement policy:

MVP provides coverage for surgical procedures that are medically necessary and meet the criteria of the policy. The use of specific surgical techniques, instrumentation, and surgical approach is left to the discretion of the surgeon.

The following codes will be included in the reimbursement of the primary procedure: