Anthem has updated its professional reimbursement policy. This policy change requires that claims with physical medicine services 97010-97799 will require modifier GP. The modifier is required for dates of service after April 1, 2021. Any PT now billed to Anthem will require the GP modifier. Note this modifier may be Read more…
It’s official: California workers’ compensation has a new Medical-Legal Fee Schedule (MLFS). These new fees and codes took effect on April 1, 2021. This will affect all QME’s of course, but also a provider who is providing a report for a disputed medical fact. There is a complete change to Read more…
CMS is temporarily holding claims from providers in anticipation of legislation that will extend the suspension of the 2 percent Medicare sequester. The Med Learn Network Connects newsletter from March 30 stated that CMS has “instructed the Medicare Administrative Contractors (MACs) to hold all claims with dates of service on Read more…
This act specifies that clinical notes collected in an electronic format must be made available in that format and made available free of charge to patients. Practices may continue using paper charts, and if you do not use electronic records, the 21st Century Cures Act likely has little impact on Read more…
JUST A REMINDER!!! 97026 & 97016 CIGNA WILL STOP PAYING THESE CODES Effective March 15, 2021, Cigna will NO LONGER pay for Heat Lamp 97026 & Vasopneumatic Devices 97016. It is effective for claims with dates of service on or after March 15, 2021. A letter from Cigna was sent Read more…
California Division of Workers’ Compensation (DWC) announced the 2021 reimbursement changes to the Physician Services section of the Official Medical Fee Schedule (OMFS), to conform to relevant 2021 changes in the Medicare payment system as required by Labor Code section 5307.1. Fees for evaluation and management (E&M 99202-99205 and 99211-99215) were Read more…
The Functional Reporting requirements of reporting the functional limitation nonpayable HCPCS G-codes and severity modifiers on claims for therapy services and the associated documentation requirements in medical records have been discontinued, effective for dates of service on and after January 1, 2019. Beginning in 2021 any use will cause the claim to be denied though they Read more…
On December 27, the Consolidated Appropriations Act, 2021 modified the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS): Provided a 3.75% increase in MPFS payments for CY 2021 Suspended the 2% payment adjustment (sequestration) through March 31, 2021 Reinstated the 1.0 floor on the work Geographic Practice Cost Index Read more…
Medicare rates were to have been reduced by about 10% for all services other than E&M codes. However, due to the recent senate and congressional voting funding additional monies to Medicare this cut was averted and will only be about 5-6% instead of 10%. Unfortunately, due to the late rulings Read more…
CMS (Medicare) has released the 2021 deductible. The annual deductible for all Medicare Part B beneficiaries is $203 in 2021, an increase of $5 from the annual deductible of $198 in 2020. Medicare fees will be published before the end of the year however, it is likely the initially published Read more…