GLMS Practice Support Department
June 14, 2019
GLMS Weekly Update Changes – Next week we will begin using a different platform to deliver your weekly dose of news from the Practice Support Department. The name will be Weekly PM Update moving forward and it will have a new, cleaner look and a one-page pdf will be included as an attachment to print and share with others in your practice. It will still come from email@example.com so if you do not receive it next Thursday, please reach out to us.
Medicare Risk Adjustment Chart Review
The purpose of the chart review is to obtain a clear picture of each member's health status. The results of the chart review are shared with the Centers for Medicaid and Medicare Services (CMS) and helps define member level health risk scores and assess HEDIS performance. Providers will soon begin receiving a request for medical records for members with dates of service between 10/1/2017 - 06/10/2019. Providers will need to work with Change Healthcare to arrange retrieval methods and time-frames of the record collection. The intent is to make this record collection as convenient as possible to your office and staff. If you have any questions, please do not hesitate to contact Change Healthcare at 1-855-767-2650.
United Healthcare 2019 Town Hall Meeting
The 2019 United Healthcare Town Hall meeting took place on Friday, June 7 at Kentucky Country Day School. Attendees had the opportunity to network with other practices and listen to presentations given by staff from United Healthcare’s Provider Relations & Payment Integrity divisions. Of the many things discussed at the town hall meeting, one significant thing to note was the recent changes that have been made to United Healthcare’s Provider Relations Claim Dispute Resolution Process. All claims inquiries must now be sent to Kentucky_PR_Team@uhc.com instead of an individual Provider Relations Specialist. For more information about this process, click here.
UnitedHealthcare Will No Longer Reimburse CPT Codes 99241-99255
UnitedHealthcare is revising their Consultation Services Policy and will no longer reimburse CPT® codes 99241-99255. This change aligns UnitedHealthcare with the Centers for Medicare and Medicaid Services (CMS). We would like to partner with care providers on older fee schedules (2009 and prior) to move to more current fee schedules. CMS ceased reimbursement of consultation services CPT codes in January 2010 and increased the Relative Value Units (RVUs) for E/M codes at that time to offset this shift in its reimbursement methodology. For this reason, UnitedHealthcare encourages providers who are on an older fee schedule to modernize their fee schedules to bring them into alignment with CMS’s current Relative Value Unit methodology, since the older fee schedule reimbursement does not appropriately align with current RVU structure for E/M services and many other procedure codes. UnitedHealthcare appreciates this change may have an impact on participating health care professionals and medical practices. So, if you have concerns or questions, or to update your fee schedule to a more current fee schedule, please reach out to your UnitedHealth Network representative. UnitedHealthcare will take a phased approach to implement this change, read further here.
FSSA Suspends Development on EnCred System (IN Medicaid)
Effective immediately, the Indiana Family and Social Services Administration (FSSA) is suspending development on the FSSA Enrollment and Credentialing (EnCred) system. The agency will take time over the next few months to identify next steps and a path forward. The FSSA remains committed to delivering on the requirements of House Enrolled Act 1007-2018, which mandates a centralized credentialing process. The agency's work to this point will help us deliver on that commitment and inform the direction we take. Future updates will be provided. The EnCred session for the Summer 2019 IHCP Provider Workshops will be removed from the schedule.
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