October 6, 2020

Blue Cross Plans Announce Settlement in Antitrust Lawsuit

Blue Cross Plans Announce Settlement in Antitrust Lawsuit It was announced on September 24, 2020, that the nation’s Blue Cross plans have reached a tentative $2.7 billion settlement in a federal lawsuit filed by their customers that accuses the group of engaging in a conspiracy to thwart competition among the individual companies, according to two people with knowledge of the discussions. The settlement, which was first reported by The Wall Street Journal, would need to be agreed to by each of the three dozen Blue Cross insurers that make up the trade group, the Blue Cross Blue Shield Association. Judge R. David Proctor of the U.S. District Court for the Northern District of Alabama, who is overseeing the case in that […]
October 6, 2020

New CPT Codes for Reporting Medical Services During the COVID-19 Public Health Emergency Period

New CPT Codes for Reporting Medical Services During the COVID-19 Public Health Emergency Period The American Medical Association (AMA) just announced updates to the Current Procedural Terminology (CPT) code set that includes two code additions for reporting medical services sparked by the public health response to the COVID-19 pandemic. The first addition, CPT code 99072, allows for the provision of evaluation, treatment, or procedural services during a public health emergency in a setting where extra precautions are taken to ensure the safety of patients as well as health care professionals. The second addition, CPT code 86413, was approved in response to the development of laboratory tests that provide quantitative measurements of SARS-CoV-2 antibodies, as opposed to a qualitative assessment (positive/negative) […]
October 6, 2020

Comments on Proposed Rules for Payment Systems and Medicare Physician Fee Schedule Due October 5

Comments on Proposed Rules for Payment Systems and Medicare Physician Fee Schedule due October 5 In August, CMS published the calendar year (CY) 2021 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule and the Medicare Physician Fee Schedule Proposed Rule. The deadline for comments on both rules is October 5, 2020. ISASS will submit comments on both rules by the deadline, but for individual members and practices interested in submitting comments, please see links below to submit comments. You can read the ISASS summary of the Medicare Physician Fee Schedule Proposed Rule Here. To submit comments on the Medicare Physician Fee Schedule Proposed Rule, click here: Comment Here You can read the ISASS […]
October 6, 2020

CMS Issues Proposed Rule for 2021 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System

CMS Issues Proposed Rule for 2021 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System On August 4, 2020, the Centers for Medicare & Medicaid Services (CMS) published the calendar year (CY) 2021 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule. Among notable changes, CMS proposes to pay the average sales price (ASP) minus 28.7 percent for 340B drugs; change the expansion exception process for a subset of physician-owned hospitals; expand the prior authorization process to include two new categories of services reimbursed under the OPPS; and eliminate the inpatient only list. Proposed Hospital Outpatient Department and ASC Payment Updates CMS proposes an increase of 2.6% for OPPS payment rates in CY […]