To help keep you informed of insurance updates, the North Chapter has compiled a couple of postings from insurance blasts.

Aetna:

Non-medical office visits

This information applies to our commercial members.

We don’t cover office visits that do not treat or diagnose a specific illness, symptom, complaint or injury unless it’s covered under a member’s benefits plan.

Some examples of non-covered exams are those needed to:

• Get or keep a job
• Travel
• Go to a school
• Go to a camp
• Join a sport or other recreational activity

Assistant therapy services billing reductions

This update applies to both our commercial and Medicare businesses.

In the September issue of OLU, we said that, effective December 1, 2023, we will pay eligible services billed by occupational therapy assistants (OTAs) and physical therapist assistants (PTAs) at 85% of allowed. We delayed the policy changes and will begin applying pay percent reductions on March 1, 2024.

Medicare:

Website: New Look, New Tools

Over the weekend of October 28-29, we will be launching a newly redesigned wpsgha.com. The new design includes two additional topic centers (Benefits & Eligibility and Documentation) to help you locate resources more easily, a new Training Center where you will find a calendar of upcoming educational events, and several new and improved tools.

Medicare Advantage PPO:

Additional incentives offered to primary care providers for Medicare Advantage PPO and HMO member compliance.

Blue Cross is offering PCPs additional incentives to help ensure our Medicare Advantage PPO and HMO members are compliant to their statin medications.

Eligible Measures:

• Statin Therapy for Patients with Cardiovascular Disease
• Statin use in Person with Diabetes

Primary care providers will earn $150 per member, per measure with gaps closed between Oct 1 to Dec. 31, 2023. PCPs can access the SUPD and SPC open gap lists in HeB. Note: Any statin intolerance exclusions billed during this time frame that remove the member from the measure denominator will count toward the incentive.

Bonus: PCPs can earn an additional incentive for member compliance in the eligible measures:

• If the member is eligible for both statin members and closes both gaps during the incentive period, PCP earns an additional $200 bonus per member.

This incentive is in addition to the current SPC and SUPD incentives currently part of the 2023 PRP program.

November Billing Buzz brought to you by MMBA North Chapter!!

                .