Best Practices Moving into the New Year
- Verify Patient Eligibility and Benefits – Many patients will have new insurance at the start of the year. Keep claim denials at bay by verifying eligibility and benefits ahead of time.
- Verify Patient Deductibles – The best practice is to communicate with patients to remind them of their deductible and that payment may be due at the time of service.
- Confirm Prior Authorization/Precertification Requirements – Many insurances update their prior authorization requirements at the start of a new year, be sure to utilize insurance websites to access this information and have a solid process in place for obtaining authorizations. Most insurances will not provide back-dated authorizations, don’t let this be a source of revenue loss for your practice.
- CPT Code Changes – Be aware of any CPT code additions/deletions/revisions.
Excellus BlueCross BlueShield Fee Schedule Updates
Reimbursement rates for the Medicaid Managed Care/Health and Recovery Plan (MMC/HARP), Child Health Plus (CHP) and Special Programs (which includes the Essential Plan) lines of business will be updated on March 1, 2023.
This change was previously set to be effective on January 1, 2023. Current rates will continue to be effective until the March 1, 2023, rate update.
Excellus Fee Schedules can be found on their website: https://provider.excellusbcbs.com/.
2023 Medicare Conversion Factor
CMS released its 2023 update of the Medicare Physician Fee Schedule (MFPS), and the Medicare conversion factor will be $33.06 for 2023. This is a decrease of 4.48% compared to the 2022 conversion factor.
The conversion factor is used to adjust the geographically adjusted RVU to determine the Medicare allowed payments for physician services.
Documentation is key to ensuring maximum reimbursement to help offset these cuts.
Unless Congress steps in, these cuts will take place on January 1, 2023.
Source: www.aapc.com
Medicare Eligibility Updated Features
New features are available when checking Medicare Eligibility.
Preventive Services Eligibility Data: You can check when your patients are eligible for preventive services. When you know past dates of service or next eligible dates, you can:
- Encourage your patients to get the preventive services they need
- Better coordinate care with other health care providers
- Help advance health equity
The next eligible date may be a future date, meaning you can’t provide the service until that date. Or it may be a past date, meaning your patient has been eligible for the service since that date and you can provide the service now. We calculate next eligible dates from claims paid under the Medicare Fee-for-Service (FFS) Program. For some preventive services, we return FFS paid claims CPT or HCPCS codes, dates of service, and NPI so you can coordinate care. Use this information along with the Medicare Preventive Services educational tool to determine coverage and frequency.
Medicare Part B Immunosuppressive Drug Benefit: Patients with Medicare because of ESRD currently lose coverage 36 months after a kidney transplant unless otherwise eligible for Medicare. Patients who meet certain criteria can qualify for continuous Medicare-covered immunosuppressive drugs. This new benefit is called the Medicare Immunosuppressive Drug (Part B-ID) benefit. The new benefit only covers immunosuppressive drugs and no other items or services.
Services:
- Acupuncture
- Cardiac rehabilitation
- Cognitive Assessment & Care Plan Services
- Pulmonary rehabilitation
- Medicare Diabetes Prevention Program
Wellpath for Oneida County Correctional Facility Billing
Effective January 1, 2023, Wellpath will begin managing healthcare services for patients at Oneida County Correctional Facility.
Claims for services on or after January 1, 2023, should be submitted to Wellpath as follows:
EDI Submission
Submit 837 Transactions
Payer ID 62111
Group # 790407
Paper Forms
C/O: HCS Correctional Management
PO Box 111890
Nashville, TN 37222
Group # 790407
Claims related inquiries should be directed to wellpathclaimscustomerservice@wellpath.us or 844-628-8681.
Introducing Wellpoint in 2023
On January 1, 2023, Amerigroup Community Care in Maryland will become Wellpoint.
There is no action that needs to be taken for their care providers. There will be no changes to any agreements or contract, reimbursement, or level of support – now or in the future – because of this branding change. Likewise, for members, the brand change will not cause any reduction to coverage or access to care.
Here are some Frequently Asked Questions they have developed with key dates and information you need to know about this change that will be regularly updated over the coming months, where appropriate. Further information will also keep you updated via their website’s Provider news and updates section, their monthly provider newsletter, and via email.