Billing Industry News

Modifier FX: payment reduction for X-rays taken using film*

Claims billed with modifier FX to indicate X-ray imaging services were provided using film reduces will be subject to a 20% reduction. The reduction applies to the technical component (TC) (including the TC portion of a global service). This reduction will be effective January 1, 2017 for Medicare plans and June 1, 2017 for Commercial plans.


Payment reduction for X-rays taken using film

Effective for services furnished beginning Jan. 1, 2017, BCBSGa will follow the Centers for Medicare & Medicaid Services’ requirement for providers to bill modifier FX when billing for X-rays using film. A payment reduction of 20 percent will apply to the technical component (and the technical component of the global fee) for X-ray services furnished using film for which payment is made under the Medicare Physician Fee Schedule.


BCBS ‘Evidence Street’ Group Enabling Engagement With MDx Players

Evidence Street, the Blue Cross Blue Shield Association’s web-based evidence review platform for medical products that’s been operational for around 15 months, is continuing to grow its influence within the diagnostics sector and among payors. Several molecular diagnostics companies, which as a sector generally cite reimbursement coverage as one of its biggest headaches, recently touted Evidence Street opinions on their tests as milestones.


65,000 providers have been cut from state Medicaid rolls

A provision of the Affordable Care Act that requires providers to revalidate or recertify their Medicaid reimbursement eligibility has caused 65,000 providers to be stripped from the federal program, according to a Modern Healthcare analysis. Providers that enrolled in Medicaid before March 25, 2011 had to send in revalidation notices to the CMS on or before Sept. 25, 2016 or risk being dropped. The ACA provision was an effort to curb fraud, waste, and abuse in the program. Modern Healthcare received data from 15 Medicaid agencies around the country.


Anthem hopes to close Cigna deal under Trump DOJ

Despite a preliminary injunction and an unwilling partner standing in the way, Anthem is still clinging to the possibility of closing its $54 billion merger with Cigna by settling with a new Justice Department under the Trump-led administration that it hopes will cut it some slack and greenlight the deal. Last week, Anthem won a temporary restraining order in the Delaware Court of Chancery to keep Bloomfield, Conn.-based Cigna from terminating its agreement to merge with Anthem.


Cigna ends merger with Anthem, sues for more than $14B

In a move that defies Anthem’s push to fight for their deal, Cigna has terminated its merger agreement with Anthem and filed suit against the larger insurer. Earlier this month, a federal judge ruled against the two insurers’ planned merger, saying it would violate antitrust law by lessening competition in the national accounts market.


Anthem will appeal ruling blocking Cigna merger

Anthem will appeal a federal judge’s decision preventing a merger with Cigna, the insurer announced. A federal judge blocked the proposed $48 billion merger of Anthem and Cigna, two of the nation’s largest health insurers. Anthem, which is based in Indianapolis, said it plans to “promptly” appeal and request an expedited hearing to reverse the decision.


Judge blocks Anthem-Cigna merger

A federal judge blocked the proposed $54 billion tie-up between national insurers Anthem and Cigna, saying the combination would harm competition in the national employer market. In a 12-page order, U.S. District Judge Amy Berman Jackson said the merger would eliminate the firms’ head-to-head competition for the administrative services business of large employers and result in higher prices and reduced innovation in the market. The judge’s decision wasn’t a surprise.


Aetna, Humana end merger agreement

Aetna and Humana have decided to end their merger agreement rather than appeal a judge’s decision to block the deal on antitrust grounds. “While we continue to believe that a combined company would create greater value for healthcare consumers through improved affordability and quality, the current environment makes it too challenging to continue pursuing the transaction,” Aetna CEO Mark Bertolini said in a statement.


Laboratory Developed Tests Demonstration Project

New laboratory-developed tests (LDTs) used to diagnose and assess various conditions have been added to the list of LDTs covered under TRICARE’s LDT Demonstration. The LDTs covered under this demonstration have not yet been approved by the U.S. Food and Drug Administration (FDA). Examples of these tests include those used for rare and emergent diseases and disorders, such as Turcot syndrome or certain types of leukemia, and those used to determine matches for organ donation.

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