Groundbreaking decision made after considering industry concerns.
In a momentous turn of events, the Centers for Medicare & Medicaid Services (CMS) has heeded the concerns voiced by the laboratory industry and chosen to withdraw the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits that affected presumptive and definitive drug tests. This significant decision comes as a relief to labs across the nation, allowing them to continue providing essential diagnostic services without the hurdles presented by the controversial coding edits.
The NCCI PTP edits, which initially took effect on July 1, 2023, drew widespread criticism from independent community and regional clinical laboratories, including the National Independent Laboratory Association (NILA) and the American Clinical Laboratory Association (ACLA). These organizations had fervently advocated for the rescission of the edits, emphasizing the potential adverse impacts on patient care and access to critical testing services.
The withdrawal decision specifically pertains to the edits between Column One codes 80305, 80306, and 80307 for presumptive tests, and Column Two codes G0480 – G0483, and G0659 for definitive tests. This monumental move underscores CMS's commitment to ensuring that laboratories can continue their invaluable role in providing timely and accurate diagnostic services to patients nationwide.
While the withdrawal of the NCCI edits is an encouraging step forward, CMS has also expressed their intent to further study the issue. This demonstrates a dedication to crafting policies that balance the need for accurate coding with the essential requirements of clinical laboratories, ensuring that patients receive the best possible care.
This development has been met with resounding approval from the lab industry, which views it as a significant victory for patient care and accessibility to essential diagnostic services. The decision not only acknowledges the concerns raised by the industry but also affirms CMS's commitment to working collaboratively with stakeholders to create policies that benefit both healthcare providers and patients.
In light of this momentous decision, the laboratory industry eagerly anticipates continued collaboration with CMS to address coding and billing challenges. The withdrawal of the NCCI edits serves as a testament to the power of advocacy and highlights the vital role of the lab industry in the broader healthcare landscape.
As the industry looks ahead, it remains committed to upholding the highest standards of patient care and providing the necessary support to ensure that diagnostic services are readily available to all who need them.
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by CoRevenue | September 8, 2023 | In the News
The purpose of this post is to bring to your attention the updated phone number for CT Medicaid HMS of 866-252-0671.
The purpose of this post is to notify you of the multiple UHC payors that are switching their communication method of letters being sent from mail to paperless beginning August and September 2023.
Recommended Action Items:
Billing/AR Team
Source: More claim letters are going paperless Aug. 4 | UHCprovider.com
The purpose of this post is to inform you of a ransomware incident that occurred on April 17, 2023 within the Harvard Pilgrim Health Care systems and the current status of the system. Please refer to the below link for more details.
Point32Health has restored its public websites and member, broker, employer and provider secure portals, which enables self-servicing for our customers. As we continue to safely and securely restore our regular services and business functions, users may notice data latency, which may impact their ability to view the most up-to-date information. We will be working to restore enrollment, eligibility and claims processing data to the present over the coming days. The data will continue to reflect information as of April 15 until we can catch up on data entry as it relates to enrollment, eligibility, claims processing and other data.
More systems and processes will come back online in the coming weeks. As we resume business operations, we look forward to sharing future updates with you.
Thank you so much for your continued patience. system update - Point32Health Provider