These articles are not comprehensive, but can help start the learning process about these government requirements.
AAOA Today Highlights: Useful Information to Help Navigate the Pathways
Billing Alert: Clarification of Aetna Limitation on Immunotherapy Dose - NEW April 25, 2013
In our most recent issue of AAOA Today and the www.aaoaf.org news section, we alerted you to a pending immunotherapy policy change by Aetna which limits the use of 95165 to 90 unit (doses) per rolling 12 month period. That communication included the following incorrect statement that we need to bring to your attention. See First Tab in the left column for more details.
Aetna Limitations on Immunotherapy
Because of concern about excessive billings for allergy immunotherapy, Aetna has established limits on the number of doses of Code 95165 which can be billed in a year
Documentation Requirements for Medicare
Several Medicare contractors have initiated prepayment audits of billings for immunotherapy billings and documentation has been requested to support the medial necessity of the claims.
New Venom and Biologic Testing Codes
Effective January 1, 2013, new codes have been established to report allergy testing for venoms, drugs and biological.
Ingestion Challenge Testing
Previously ingestion challenge testing for food, drugs or other substance was reported under Code 95075. That code has been deleted and effective January 1, 2013 is replaced by two new codes 95076 and 95079.
2013 Medicare Physician Fee Schedule - Final Rule Summary
On Friday, November 16, 2012, the Centers for Medicare and Medicaid Services (CMS) published the final Medicare Physician Fee Schedule (PFS) Rule for 2013 in the Federal Register. The final rule updates payment policies and payment rates for services furnished under the PFS and includes changes to the quality reporting initiatives associated with the PFS – the Physician Quality Reporting System (PQRS), the Electronic Prescribing (eRx) Incentive Program, and the physician value-based payment modifier.
Retaining Independence Part I, II, & III
Physicians throughout the country are trying to figure out how to best achieve their professional goals in the changing health care delivery environment. Physician payments are increasingly being structured in a way that incentivizes quality and cost effectiveness over volume, and many place physicians at financial risk.
To navigate the various news topics, click on the right hand tabs to learn more about each area of interest.