RCM eNews – April 2024

STI RCM is transitioning all Practice Manager based clients from Change Healthcare to Waystar clearinghouse. Make note during this transition, we are still actively sending claims to payers as we have, until set up and the enrollments are approved. Your account representative will be in touch with you soon, if they have not already, regarding enrollments and successful claim submissions.

From CMS:

On March 9, 2024, President Biden signed the Consolidated Appropriations Act, 2024, which included a 2.93 percent update to the CY 2024 Physician Fee Schedule (PFS) Conversion Factor (CF) for dates of service March 9 through December 31, 2024. This replaces the 1.25 percent update provided by the Consolidated Appropriations Act, 2023, therefore the CY 2024 CF for dates of service January 1 through March 8, 2024 is $32.74. CMS has implemented the new legislation by adjusting the CY 2023 CF of $33.07 by 2.93 percent and the budget neutrality adjustment for a CY 2024 CF of $33.29 for dates of service March 9 through December 31.

National Government Services has an updated Prolonged Services Timetable, you can refer to this table to ensure you’re billing claims for prolonged services correctly.

CPT Code	HCPCS Code for Prolonged Service	CPT and CMS Base Time	CMS-Extra Minutes Needed	CMS Time Requirement for Prolonged Services	Date Span
99205	G2212	60	15	75	DOS
99215	G2212	40	15	55	DOS
99223- Hosp/Obs	G0316	75	+15 (same as CPT)	90	DOS
99233- Hosp/Obs	G0316	50	+15 (same as CPT)	65	DOS
99236- Same Day Admit/Disch	G0316	85	+25	110	DOS + post 3 days = 4 days
99306- SNF initial	G0317	50	+50	95	1 pre-DOS, DOS, 3 post-DOS = 5 days
99310-SNF Subsequent	G0317	45	+40	85	1 pre-DOS, DOS, 3 post-DOS = 5 days
99345- Home/Residence Initial	G0318	75	+65	140	3 pre-DOS, DOS, 7 post-DOS =11 days
99350- Home/Residence Subsequent	G0318	60	+50	110	3 pre- DOS, DOS, 7 post- DOS = 11 days
99483- Cognitive Behavior Assess.	G2212	60	+40	100	3 pre-DOS, DOS, 7 post- DOS = 11 days

United Healthcare’s Prior Authorization Crosswalk can help determine next steps when you need to provide a service that is different from an approved service, as well as help you bill for an appropriate code and decrease claim rework.

Starting April 1, 2024, the Prior Authorization Crosswalk will feature new updates to:

• Include a more comprehensive list of CPT® and HCPCS codes
• Apply to more UnitedHealthcare plans, including:
  • Commercial
  • Individual Exchange
  • Medicare Advantage
  • United Healthcare Community Plan
• No longer have a Code Category column

Please note, until the update on April 1, 2024, the crosswalk will continue to only apply to UnitedHealthcare commercial plans and will continue to show the Code Category column.

As of January 1, 2024, the breast milk storage bag CPT code K1005 has been replaced with CPT code A4287. When submitting claims, be sure to use the new code. Claims submitted using the old code may be denied.

Changes are coming soon to your United Healthcare Provider Portal access. If you use the portal, you’ll need to update your One Healthcare ID authentication options to retain access.

This is the preferred authentication method and has been available since July 2023. If you’ve already set up authenticator, you’re off to a good start. Please note, you may want to adjust or add additional authentication or recovery options as they become available.

To support this change, United Healthcare has created several resources for you to reference. These will be updated as information becomes available to support your organization.

• Provider Portal authentication page: View the most current authentication details and resources
• One Healthcare ID Security Change Support Guide: Get more details and step-by-step instructions on how to update your authentication sign-in option

In summer 2024, United Healthcare will also be removing email as a sign-in and recovery option. If authenticator is not an option for your organization, they are also working on other solutions to meet your needs. These options will be coming later in 2024 and details will be added to the above resources when available.

With this change, each user will need their own unique One Healthcare ID. To set up a One Healthcare ID or for instructions on connecting to a tax ID number (TIN), please visit UHCprovider.com/access. Please note, administrators can bulk add new users with appropriate access, but new users will still need to create their own One Healthcare ID.

Effective January 1, 2024, NYS Medicaid fee-for-service (FFS), and effective April 1, 2024, for Medicaid Managed Care (MMC) Plans, NYS Medicaid provides reimbursement for Adverse Childhood Experiences (ACEs) screening conducted in primary care settings for children and adolescents up to 21 years of age. An annual ACEs screening will be covered, as determined appropriate and medically necessary.

Code	Modifier	Description	Annual Allowance per Member	Reimbursement Rate
G9919	U1 and U9	Screening was performed and positive*, provision of recommendations is used for high-risk patients.	1 Screen	$29.00
G9920	U1 and U9	Screening was performed and negative.	1 Screen	$29.00

*Clinician to determine if an ACEs screen is positive.