LVHN’s Payer Relations Team has created
an Insurance Services Payer Update Tracker
LVHN’s Payer Relations Team has created an Insurance Services Payer Update Tracker to help keep you apprised of frequent payer changes in allowable services, billing updates, and all things COVID-19. Additional pertinent information is also attached. (see links below)
Some highlights of today’s additions:
- CMS - waiver of PART B cost sharing related to COVID-19
- CMS – new modifier for Medicare claims to signify waiver of cost sharing
- CMS issued several video presentations
- Additional payers waiving IP cost sharing for COVID tx (IBC)
- Continued suspension/relaxing of prior authorization requirements for post-acute care (IBC)
Tracker Overview:
- COVID All Payers Tab – Payer specific links/Information Overviews
- Telemedicine Summary Tab – Grid of allowable telemedicine services by payer/products/ Expected reimbursements
- Telemedicine Detail Tab – Payer Specific Definition of Services allowable/Links to applicable payer information/Audio Visual v. Audio Alone allowable services
Payer Themes
- OMAP issues memorandum to MCOs regarding processing of elective medically necessary services & elective life sustaining services
- OMAP Hydroxychloroquine Quantity Limits
- CHIP – CHIP MCO’s are to temporarily suspend disenrollment of enrollees due to financial or administrative burdens
- Payers monitoring potential impacts COVID-19 will have on Quality component of Value Based Programs
- Payers reimbursing providers full allowance on those services they are waiving cost sharing due to COVID-19
- Payers extending timely filing deadlines (UHC)
- Payers allowing Telemedicine for new patients
- Payer extensions on new authorizations and prior authorizations
- CMS Immediate Temporary Provisions & Expansions in place during Public Health Emergency
- CMS Telehealth Service Expansion; Payers following (Highmark released expansion list, CBC evaluating)
- Payer guidance regarding reporting of temporary provider locations under PHE
- Payers waiving cost sharing for COVID-19 related treatment, including IP admissions
- Payers suspending pre & post claim reviews; suspending pre-auth requirements & referrals
- Payers lifting preauthorization requirements in many areas
- Payers providing dedicated member lines for COVID-19 support
- Payers waiving cost sharing for telemedicine COVID-19 and NON-COVID-19 dx – continued trend
- Payers waiving pre-auth for COVID-19 related testing
- Payer – new lab testing guidelines & establishing reimbursement rates for COVID-19 labs
- Medicare/CMS guidelines to cover Medicare Annual Wellness Visits via Telemedicine – Medicare Advantage following (Highmark. UHC, Aetna, CBC, and now Geisinger confirmed)
- OMAP – Issued MCO Memorandum that MCO’s may no longer require authorization for chest CT related to COVID-19, effective 03.17.2020
- Payer updates continue to FAQs & Telehealth Guidelines
- Payer updates regarding coding and reimbursement, including telehealth/telemedicine/virtual visits
- Payer updates regarding Peer to Peer review timelines (Highmark)
- WC - Audio-Visual & Audio only telemedicine services reimbursable. *PT/OT/ST preferred method is audiovisual
- Continued expansion of PT/OT/ST services under Telemedicine
- CMS – “Provider Enrollment Relief” hotlines & FAQs regarding temporary enrollment
- Payers suspending prior auth requirements for Post Acute Care settings/SNF, LTAC, AIR
- Waiving of out of pocket amounts for video visits, COVID related testing and screening, and IP care
- Payer updates regarding authorization effective dates & elective procedures (MA FFS)
- CMS relief related to Quality Reporting Programs
- Telehealth expansion applies to behavioral health services delivered to MA beneficiaries via FFS or through a BH-MCO
- Medicare/CMS: 1135 Waivers; Telehealth FAQs related to 1135 Waiver; Practitioner enrollment for temporary billing privileges; Expediting pending & new application for “All Other Providers and Suppliers (including DMEPOS)
- DHS files WAIVER – approved
- Medicaid: Waiver of Prudent Pay; Billing Guidance for Alternative Screening Sites Released
Please feel free to share this with anyone requiring the information!
We will update as trends and updates are received.
Download these files for reference
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