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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.

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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.

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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.

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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.

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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.

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