2023 Articles

UHC MA-PCPi Program United Healthcare has made a few updates to the 2023 MA-PCPi (Medicare Advantage Primary Care Physician Incentive program). The changes apply to Q4 2023 only. For additional information, please refer to the following art...

COVID-19 Vaccine Codes Please see the linked article from the American Medical Association's (AMA) CPT assistant guide. It describes which CPT codes are valid for the upcoming winter season and which have been eliminated. https://www...

Z Codes CMS (Centers for Medicare and Medicaid Services) has recently released a graphic that could help shed some light. https://www.cms.gov/files/document/cms-2023-omh-z-code-resource.pdf ...

2023 E & M Code Updates CMS has "made significant updates to the language, order, and formatting of this product to better meet provider needs and improve understanding." Attached is a link to their 2023 Evaluation and Management Services ...

CMS Website Did you know that CMS has recently redesigned its website? The updated version promises streamlined navigation and a refreshed landing page. They are looking for comments via a feedback button located on each page. ...

UHC Reauthorization Requirements Using a phased-in approach, United Healthcare has removed reauthorization requirements from many plans for many different services. Please see this listing from United Healthcare: https://www.uhcprovid...

New POS Code The Centers for Medicare and Medicaid Services (CMS) has created a new place of service code 27 to use when services are provided in a non-permanent location, effective October 1, 2023. If you provide services to patients ...

Updated ABN Were you aware that the Centers for Medicare & Medicaid Services (CMS) updated the Advanced Beneficiary Notice (ABN) form? The new form CMS-R-131 is mandatory as of 6/30/2023. Any ABN signed after 6/30/2023 that is on the previ...

No Surprises Act Curious about how the first year of the No Surprises Act has gone and what impact it has had on the healthcare market? Check out this article from the American Hospital Association. https://www.aha.org/news/headline/...

DME Claim Cap Beginning July 1, 2023, Medicare will begin limiting the patient's out-of-pocket cost to $35 for a month's supply of insulin used in an insulin pump. Medicare is advising to refrain from billing for supplies of insulin ...

Phase out of paper checks According to United Healthcare (parent company of Oxford Health Plan), they will discontinue the issuance of paper checks for claims payment for "many... Oxford plans in Connecticut, New Jersey, and New York" sometime i...

New ID Cards According to United Healthcare (UHC), a new wave of members will be transitioned to their new commercial claims processing system. All transition members will receive a new ID card beginning April 1, 2023. The members will have ...

PHE Ends CMS (Centers for Medicare and Medicaid Services) has published an article and fact sheet explaining the impact on providers and patients if the PHE expires in May 2023 as scheduled. The fact sheet covers critical elements such ...

NDC Updates Are you aware of the NDC changes coming from CMS effective July 1, 2023?  Check out the article below for more details. The impacted codes include: NCD 20.4 - Implantable Cardiac Defibrillators (ICDs) NCD 20.7 - P...

Medicare Processing Error According to Palmetto GBA, (CMS- Centers for Medicare & Medicaid Services MAC Processor), claims with dates of service January 1, 2023, and forward billed with a combination of POS codes 19, 22, 23, or 62 with CPTs 992...

Virtual Card Payments Coming Soon Beginning February 3, 2023, United Healthcare (UHC) will stop mailing VCP (Virtual Card Payment) statements and instead offer them through their UHC Provider Portal for you to view and/or print as needed. ...

Beginning with the date of service January 1, 2023, you no longer need to submit certificates of medical necessity (CMN) or durable medical equipment information forms (DIF) for Medicare patients. CMS has stated that if they are included, the...

Each year, the AMA releases new and revised codes that reflect what is happening in medicine and upon feedback received from medical providers. New technology, new viruses/illnesses, and new understandings are all considered whe...

Did you know that beginning February 1, 2023, you will be able to submit claim appeals and reconsiderations electronically through UHC's portal? According to UHC, this change will affect commercial and Medicare Advantage plans. It does ...

Effective January 1, 2023, Medicare is eliminating certificates of medical necessity (CMN) and durable medical equipment information forms (DIF) for some services. If either a CMN or DIF is submitted with claims for dates of service January...

The Centers for Medicare and Medicaid Services (CMS) has released the 2023 Clinical Lab Fee Schedule. It includes mapping new CPTs for clinical lab testing and updates for costs subject to the reasonable charge payment. The files can be acces...

Due to the massive (2,066 pages) size of the CY2023 Medicare Physician Fee Schedule, CMS has released a 12-page summary of the key provisions that you need to know. Comments can be made on the proposed fee schedule until September 6, 2022. The...

The Centers for Medicare and Medicaid Services (CMS) recently released its proposed CY 2023 fee schedule that included specific provisions related to telehealth. Highlights include: Extending services added to the Medicare Telehealth se...