JUNE 2017 BILLING UPDATES

by Tammy Bartlett, Billing Manager

INDEPENDENT HEALTH

Effective May 1, 2017, Independent Health (IHA) will recognize “incident to” billing practices for their Commercial, Medicare Advantage and Self-Funded plans.  IHA’s state products (MediSource, MediSource Connect, Child Health Plus and Essential Plan) will not be eligible for “incident to” billing.

Please ensure your staff carefully reads IHA’s requirements for “incident to”, which can be found in their Participating Practitioner Reimbursement Manual, located on their website at:

https://www.independenthealth.com/Portals/0/PDFs/MyProviderAccount/ToolsResources/Resources/2017ParticipatingPractitionerReimbursementManual.pdf

The guidelines for “incident to” begin on Page 10. Any questions pertaining to these requirements should be directed to the following email address:  Reimbursement.Manual@independenthealth.com

After the implementation of this new policy, IHA will conduct audits to ensure their requirements are being met by the provider community.

CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS)

SCREENING FOR HEPATITIS B VIRUS INFECTION

On May 17, 2017, CMS updated their policy for Hepatitis B coverage as reflected in bold print below.

Payment for Hepatitis B will apply to the following HCPCS and CPT codes, effective for dates of service on or after September 28, 2016: G0499, 86704, 86706, 87340 & 87341.  CMS will allow coverage for HBV screenings only when services are ordered by the following provider specialties found on the provider’s enrollment record.

  • 01- General Practice
  • 08- Family Practice
  • 11- Internal Medicine
  • 16- Obstetrics/Gynecology
  • 37- Pediatric Medicine
  • 38- Geriatric Medicine
  • 42- Certified Nurse Midwife
  • 50- Nurse Practitioner
  • 89- Certified Clinical Nurse Specialist
  • 97- Physician Assistant

Claims submitted by providers other than the specialty types noted above will be denied.

For Billing questions, please contact Tammy Bartlett at 716-348-3923 or tammyb@pracfirst.com

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