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UHC placing ‘pre-pay’ review on some Covid claims

UHC placing ‘pre-pay’ review on some Covid claims

by Alex Mitchell | Mar 22, 2021 | Revenue Cycle Management, Pathology Management, Denial Management

Multiple labs we work with have recently received pre-payment records requests from UnitedHealthcare to support their Covid-19 testing. While UHC isn’t denying these tests for improper coding, the payments they’ve put on hold amount to nearly $1 million in...
Medicare clarifies billing rules for second run Covid-19 variant tests

Medicare clarifies billing rules for second run Covid-19 variant tests

by Alex Mitchell | Feb 22, 2021 | Revenue Cycle Management, Pathology Management, Billing & CPT Codes

When re-testing Covid-19 specimens to check for variants, Medicare has indicated you may bill U0004 for the second-run of a high-throughput test. For example, if a specimen tests positive, you may run the sample again to check for variants and bill U0004 (or the same...
2021 Covid-19 coding update

2021 Covid-19 coding update

by Alex Mitchell | Feb 4, 2021 | Revenue Cycle Management, Billing & CPT Codes

The following Covid-19 coding changes are effective as of Jan. 1, 2021: REMOVE: Z20.828 should NO LONGER BE USED for possible or suspected exposure to Covid-19 for dates of service (DOS) on or after Jan. 1, 2021. Z11.52 should NO LONGER BE USED for encounter...
2021 Medicare Fee Schedule boost: See impact to pathology services

2021 Medicare Fee Schedule boost: See impact to pathology services

by Alex Mitchell | Jan 13, 2021 | Pathology Management, Billing & CPT Codes, CMS Fee Schedules

As part of the COVID relief and appropriations package signed into effect Dec. 27, Congress took steps to mitigate significant fee schedule reductions for several specialties that were designed to offset payment boosts for evaluation and management (E/M) services....
UHC now requiring G0416 for prostate biopsies across all products

UHC now requiring G0416 for prostate biopsies across all products

by Alex Mitchell | Jan 11, 2021 | Billing & CPT Codes

FYI: This post originally ran in October 2020 when UHC first announced this move. We have bumped it to the top of our blog as a reminder the policy change is now in effect. After making the move to align prostate biopsies with G0416 for Medicare Advantage plans...
Pathology sees 9% cut in 2021 MPFS Final Rule

Pathology sees 9% cut in 2021 MPFS Final Rule

by Alex Mitchell | Dec 2, 2020 | Billing & CPT Codes, CMS Fee Schedules

After a lengthy delay, CMS released the 2021 Medicare Physician Fee Schedule Final Rule Tuesday. It finalizes several telehealth flexibilities introduced during the public health emergency while also significantly overhauling reimbursements for evaluation and...
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