Anthem Blue Cross denying certain E&M services with modifier -25 for claims processed on or after March 1.

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This Weekly’s Hot Topics

  • Anthem Blue Cross denying certain E&M services with modifier -25 for claims processed on or after March 1. California News
  • April 2, deadline for MIPS submission for Year 2 of Quality Payment Program CMS News
  • Next week, attend the year’s most important conference in community oncology! Affiliate Association News

Anthem Blue Cross recently announced that it is denying certain evaluation and management (E&M) services submitted with modifier -25 for claims processed on or after March 1. Modifier -25 allows separate payment for a significant, separately identifiable E&M service provided on the same day as a minor procedure or other reported health care service. To read more click here and go to California News.

COA NEEDS ANY NEW STORIES about any PBM bad behavior, in preparation for the Senate Finance Committee hearing on PBMs scheduled for the second week in April. It is expected that representatives from the top 5 PBMs will be testifying. The Community Oncology Alliance (COA) is going to provide key Senate offices with information on all aspects of PBM bad behavior, including patient medication delays and denials, DIR fees, patient trolling, network exclusions, etc., etc., etc. To read more click here and go to National News.

Next Tuesday, April 2, is the deadline for MIPS eligible clinicians who participated in Year 2 (2018) of the Quality Payment Program (QPP) to submit their data and update information, with the following exceptions: Clinicians who reported Quality measures via Medicare Part B claims throughout the 2018 performance year, CMS was to have received your quality data from claims processed by your Medicare Administrative Contractor, and claims for services furnished during 2018 must have been processed within 60 days after the end of the 2018 performance period. To read more click here and go to CMS News.

Next week, attend the year’s most important conference in community oncology! The 2019 Community Oncology Conference, April 4-5, 2019, will focus on ensuring quality, affordable and accessible cancer care. Networking with community oncology practices and allied professionals from across the country, sharing insights on how to overcome the challenges you face on a daily basis. To read more click here and go to Affiliate Association News.

To read the complete California Oncology Weekly Newsletter, click on the date below.

March 26, 2019

 



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