RCM eNews – March 2024

CMS recently released a transmittal for Medicare Administrative Contractors (MACs) to put into place the agency’s suspension of the Appropriate Use Criteria for Advanced Diagnostic Imaging (AUC) program. The action to pause the AUC program occurred when the CY 2024 Medicare Physician Fee Schedule (MPFS) final rule went into effect on January 1, 2024.

With this program being suspended, providers and suppliers of advanced imaging services will no longer need to include AUC consultation information on MPFS claims. CMS intends to terminate the HCPCS G Codes and Modifiers that have been used to make reports of AUC consultation, but not until year end to allow final claims with dates of service of 2023 and 2024 to be adjudicated though that period.

MACs have been instructed to have removed all national and local edits related to the AUC program and to have discontinued their use as they process claims for outpatient advanced diagnostic imaging tests with dates of service on or after January 1, 2025.

For further details regarding the ppropriate Use Criteria for Advanced Diagnostic Imaging (AUC) Program suspension, click here and here.

The following updates have been made to the Medicare Preventive Services guidelines. For full details, click here.

• Annual wellness visit: Added G0136 for Social Determinants of Health Risk Assessment as an optional element and information about community health integration initiating visit
• Colorectal cancer screening: Use the KX modifier when billing screening colonoscopies as a follow up to a non-invasive test.
• Diabetes screening:
  • Patients can get 2 screenings within a 12-month period.
  • Starting in January 2024, Medicare will cover an A1c blood test for patients getting a diabetes screening.
• Diabetes self-management training: Added information on:
  • Telehealth qualifications and flexibilities
  • Registered dietitians and nutrition professionals performing and billing services
• Flu shot: Added information about additional payment for in-home flu shot administration.
• Medical nutrition therapy: Added information about registered dietitians and nutrition professionals performing and billing services.
• Medicare Diabetes Prevention Program:
  • Updated HCPCS and CPT codes and frequency for CY 2024
  • Added information on the extended flexibilities period
• Sexually transmitted infection (STI) screening and high intensity behavioral counseling to prevent STIs:
  • Added CPT code 0402U effective October 1, 2023.
  • Updated the ICD-10 codes section.

Several of the Medicare MACs were underpaying telehealth services that were billed with POS 10, paying at the facility rate rather than the higher paying non-facility rate. Each MAC will be doing a mass adjustment of the claims that were underpaid.

Medicare MAC, National Government Services, has expanded their E/M FAQs for the Complex and Chronic Care code G2211 to include answers to common questions about the usage of this new code. Click here for the details.

As of April 1, 2024, United Healthcare commercial plans will require DEX Z-Codes for certain molecular test services on facility and professional claims.

This requirement will roll out in phases based on the type of test being performed.

You will need to register with the DEX registry for the following services:

• Adult molecular diagnostic tests relevant to Medicare age population, except inherited cancer testing
• Prenatal carrier screening tests
• Specific services billed under 81479
  • Genetic disease carrier status for procreative management
  • Pharmacogenomics testing (PGx), including single-gene and multi-gene panels

Additional phases are being planned for later in 2024 for other molecular pathology services.

Additional information can be found here.

As of February 8, 2024, Horizon BCBS of NJ, Braven Health, and Horizon NJ Health have joined the Availity Essentials Provider Portal. You can use the self-service tools on the Availity Essentials portal for:

• Claim Submission
• Claim Status
• Member ID Cards
• Eligibility & Benefits
• Remittance Viewer/Explanations of Payment
• Claim Attachments
• Additional Payer Space applications, including Cost Share Estimator and HorizonDocs

At this time, access to NaviNet will still be available, however, you are encouraged to sign up and being using Availity Essentials.

For further details, click here.

The Workers Compensation Board has announced some enhancements to the OnBoard system. Healthcare providers will no longer be required to submit a PAR drafted by their delegates. Delegates can now draft, attest to, and fully submit a PAR in OnBoard.

With this enhancement the “Ready to Submit” will no longer be an option, delegates will now select “Attest and Submit” to submit the PAR for review.

The training webpages have been updated here.

NY State of Health has released a provider fact sheet titled, Unwinding the Public Health Emergency.

The fact sheet includes information to assist patients, who may be affected by the PHE unwind, the Medicaid renewal process, and other health insurance options available.