Insurance news
Optum Changes Policy on Using Modifier with 98943-51
Written by Edior   
Tuesday, October 14, 2014 10:34 AM

In Optum's quarterly newsletter, Optum Physical Health News, the company announced a change to its long-standing policy requiring modifier -51 be appended to 98943 when billed with spinal CMT codes 98940-98942. The newsletter states:

"Start Your Engines"- ICD-10 is Back on Track!
Written by Editor   
Tuesday, October 14, 2014 10:24 AM

On Aug. 4, 2014, the U.S. Department of Health and Human Services (HHS) issued a rule confirming Oct. 1, 2015 as the new compliance date for healthcare providers, insurance plans, and clearinghouses to transition to ICD-10, the tenth revision of the International Classification of Diseases. In light of this new implementation date, it is vital that clinics take the time to consider the Implementation Timeline.

TDI-DWC Reports on Federal Reclassification of Hydrocodone Combination Drugs
Written by Editor   
Friday, September 26, 2014 04:05 AM

In a September 23, 2014, memorandum the Division of Workers' Compensation of the Texas Department of Insurance reported that "On August 22, 2014, the US Drug Enforcement Administration (DEA) published a final rule in the Federal Register ( )reclassifying hydrocodone combination drugs from Schedule III to Schedule II in the Schedule of Controlled Substances."

They also note "hydrocodone combinations are the most frequently prescribed drugs in the Texas workers’ compensation system and are impacted by this change."

The Federal rule includes notations that "This reclassification is not only justified given the high abuse and addiction potential of hydrocodone prescription painkillers * * *, it is necessary to combat the drug abuse epidemic that is destroying so many [ ] communities."

Blue Cross And Blue Shield Of Texas Transparency Solution Helps Consumers
Wednesday, September 24, 2014 04:11 PM

As consumers look for new ways to obtain the best possible care and lower their health care costs, Blue Cross and Blue Shield of Texas (BCBSTX), the largest provider of health benefits in the state, announces the enhanced Provider Finder, an online health care solution developed to enable members to more easily research and select physicians and hospitals, as well as estimate out-of-pocket health care costs. The Provider Finder provides cost estimates for more than 400 common medical procedures, increasing to 1600 by the end of the year.

Provider Finder allows members to search and compare more than 400,000 health professionals and 21,000 facilities nationwide, estimate treatment costs, access clinical quality data and read and write patient reviews. BCBSTX analyzed the use of Provider Finder for approximately 800,000 members and found that members who acted on a Provider Finder recommendation saved on average $900 per procedure.

CMS Policy Change: Requirements for Collecting Provider Overpayments
Written by Editor   
Tuesday, June 24, 2014 05:00 PM

The Centers for Medicare and Medicaid Services (CMS) recently published a notification to all providers regarding updates to the policy and instructions to portions of the overpayment process. If a Medicare overpayment remains outstanding and collectible, an Intent to Refer (ITR) letter will be issued 66 days from the initial demand letter date.

This is a change from 120 days from the initial demand letter date. This new policy will take effect on July 7, 2014.

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