June 3, 2021
Several payment policies received some significant revisions to their content that will affect claims reimbursement later this year. The policy revisions include:
- Hospital and Hospital System Readmissions policy
Effective with claims processed on and after September 3, 2021, the readmission period will be reduced from 14 days to 5 days of a prior acute care inpatient hospital or hospital system discharge. The policy is also being expanded to apply to not only facility claims paid by DRG and facility claims reimbursed on a non-DRG methodology.
- Medicare Indicator Status B Services Reimbursement policy
In compliance with the recently signed Washington State Senate Bill 5169 (2021), this policy has been revised to allow payment of CPT code 99072-personal protective equipment to Washington state providers onlyfor the duration of the federally declared public health emergency. This is effective for claim dates of service on and after April 16, 2021. All other non-Washington provider submissions of this code will still be subject to the policy criteria and denied reimbursement.
- Personal Protective Equipment (PPE) policy
In compliance with the recently signed Washington State Senate Bill 5169 (2021), this policy has been revised to allow payment of CPT code 99072-personal protective equipment to Washington state providers only when those member's benefits allow reimbursement for this service for the duration of the federally declared public health emergency. This is effective for claim dates of service on and after April 16, 2021. All other non-Washington provider submissions of this code will still be subject to the policy criteria and denied reimbursement.
- Unlisted, Non-Specific and Miscellaneous Procedure Codes policy
The table of codes listed in the policy has been updated. The requirements for supporting documentation that must accompany the submission of an unlisted or miscellaneous code has been expanded upon with more specific details on the kinds of documents to submit. Failure to provide the documentation with the submitted code will result in a delay in payment of the service or a denial of reimbursement. The new documentation criteria become effective with claims process on and after July 5, 2021.
Sign in to your One Health Port account to review the full details of each of these policies.