#reimbursement – Page 11 – KR2 Medical Billing

UHC Community Health (NY): nerve block reimbursement policy

Posted on June 29, 2021June 29, 2021 by KR2Medical Billing

Most commonly I receive the questions regarding separate reimbursement of nerve blocks like TAP (Transversus abdominis plane (TAP) block for abdominal surgery)- codes 64486 – 64489 Transversus abdominis plane (TAP) block. Unfortunately every insurance payer has its own policy regarding nerve block reimbursement. So, making sure that your medical biller knows where to look for that information is imperative to reduce unnecessary denials and improve your A/Rs.

If you are a surgeon that accepts UHC Community health patients then this blog post is for you!

According to UHC Community Health Provider communications: the below policy will be effective for DOS on or after 07/01/2021.

This change is made to align with NY State regulations.

The following is said:

“Administration of a nerve block (either as a component of the anesthesia itself or a postoperative pain management protocol) is considered part of the anesthesia time for the surgery. This will not be reimbursed as a separate and distinct procedurals services when performed by the same provider (or his/her associate) that has provided the same anesthesia for the surgical procedure itself. “

Also Post Op visits are included in the total value for anesthesia services.

Healthy Medical Coding and Billing Practices: FREE MEDICAL BILLING AND CODING ADVICE!

It is important to make sure you are billing the proper codes. Billing code 69990 is not acceptable for TAP done for Laparoscopic procedure. Billing this code will trigger unnecessary denials and if you are an OON provider will not be as a “covered procedure” and the “provider total charge” will be applied to patient responsibility.

Need medical coding and billing training for your staff? Please visit my Services Page to register for my on demand or live training/consulting sessions. (via zoom/google meets)

Need a speaker? Please visit my Services Page to fill out the request form.

#nerveblock #cpt69990, #cpt64486, #denials, #uhccommunityhealth, #reimbursement

MVP (NY/VT) Insurance Payer, Pharmacy (Various Insurance Payers), Training, Updates

NY Managed Medicaid Plans Reimbursement Update: Pharmacies 05/01/2021

Posted on April 2, 2021June 8, 2021 by KR2Medical Billing

Starting 05/01/2021– The prescriptions will no longer be covered and paid under the Managed Medicaid Plans (ei. MVP). Instead the prescriptions will be covered under NY Medicaid Fee for Service Fee Schedule.

Where can I find the list of covered medications?

Medicaid Fee for Service has a list of covered medications. OTC (over the counter medications and most other medications are on that list. The list can be found on emdNY website.
Medicaid Fee for Services also has a preferred medication list. This list can be found by clicking here.

Do I have to participate in NY Medicaid Fee for Service?

As a pharmacy (provider) you will need to participate in NY Medicaid Fee for Service, in order to fulfill the Managed Medicaid Patient RXs.

What else do I need, in order to process claims?

A Managed Medicaid Member has to show you their NY Medicaid Card or your Health Plan Card. As a Participating Pharmacy Provider you will need the CIN number in order to file your claims.

For General Information and Updates please click here.

#Medicare, Training

Do you know what is your Local CMS MAC?

Posted on March 23, 2021June 8, 2021 by KR2Medical Billing

As a provider you see Medicare patients and file their claims to Medicare every day, but do you know who is the one the processes those claims?

Well, the short answer is your Local CMS MAC.

What is a Local MAC? MAC stands for Medicare Administrative Contractor- a private healthcare insurer that processes the fee-for-services claims for Medicare Part A/B beneficiaries, Home Health, and DME claims.

According to CMS.gov as of 2019 there are 13 Medicare A/B MACs and 4 DME MACs. They are responsible for processing claims for ” nearly 68% of Medicare population”.

MACs provide LCDs- Local Coverage Determinations for services that are done by you-provider. By contacting your local MAC you can find out if a service or medication is covered or not. This step will help you reduce the number of your unnecessary denials and decrease the amount of days in your A/Rs.

I am located in New York, so my local MAC is for Jurisdiction K- Medicare Part B claims ONLY. The company that provides LCDs and processes my claims is NGS or National Government Services.

Below are the most current A/B MAC + DME MAC jurisdictions.