TriWest Healthcare Alliance’s (TriWest) new claims processor – PGBA – will start accepting and processing all Department of Veterans Affairs (VA) Community Care Network (CCN) health care claims and any remaining Patient-Centered Community Care (PC3) claims effective June 9, 2021 VA claims must now be submitted under a new Payer Read more…
Modifier GP is being adopted by additional carriers as a requirement for reimbursement of physical medicine services. This always therapy modifier is required by United Health and its affiliates since 2020. The modifier GP is also required for VA claims and Medicare (note Medicare does not pay for the therapies Read more…
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…
Itâs official: California workersâ compensation has a new Medical-Legal Fee Schedule (MLFS). These new fees and codes took effect on April 1, 2021. This will affect all QMEâs 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 âinstructed 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 Workersâ 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 for pain and functional scales (G8539, G8730 by example) to Medicare are no longer required. In fact use of the codes will result in the claim being denied effective for dates of service on and after January 1, 2019. Beginning in 2021 any use will cause 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…