Tag: #medicalcoding

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:

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

MVP (NY) COVID-19 Vaccine Proper Billing and Coding guidance

Posted on by KR2Medical Billing

The following medical billing and coding Guidance, for COVID-19 vaccines, ONLY applies to New York Providers.

As per MVP: ALL COVID-19 vaccines are covered for all PLANS without a member cost-share.

In order to get reimbursement, providers need to follow the proper COVID-19 vaccine billing and coding guidance.

For MVP Medicare Patients:

Providers please bill Medicare Fee-for-Service (FFS) directly for the vaccine and administration of the
vaccine to MVP Members enrolled in Medicare Advantage in 2020 and 2021. If Providers will bill the COVID-19 claims to MVP, they will be denied.

For MVP Commercial and Managed Medicaid Patients:

Since COVID-19 vaccines are provided by the government at no charge, Providers should not bill the Vaccine codes (please see below Picture 2). Instead providers should only bill the administration codes (see below Picture 1).

(Picture 1)
(Picture 2)

MVP will reimburse both In Network and Out of Network providers.

Posted in Training, Updates

NY Medicaid Reimbursement for COVID-19 testing and Specimen Collection (for Pharmacies)

Posted on by KR2Medical Billing

Coding Guidance for Pharmacies

New York Medicaid plans will reimburse Providers for COVID-19 specimen collection or CLIA waived COVID-19 testing for Medicaid Members, when such collection or testing is in compliance with the Governor’s Executive Order #202.24. 

* For Pharmacies- do not bill for Specimen Collection. Reimbursement includes the COVID-19 testing and specimen collection. Furthermore, if the Pharmacy is receiving payment from another insurance for COVID-19 testing or lab specimen collection, the Pharmacy SHOULD NOT bill NY MEDICAID.

To see the full announcement please click here.