August 2021
Provider eConnection
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IPN News and Events
that you don't want to miss!
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2021 Idaho Health Care Conference
August 5th and August 10th : 9:00 a.m. to 3:00 p.m. MST
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The Idaho Health Care Conference (IHCC) committee invites you to attend one of the FREE, virtual conference sessions to hear from major health care payers, government contractors, third-party payers and networks in Idaho. Click the Join LIVE Zoom meeting on the day of your choice. Space is limited to 300 attendees. Log on early and limit to 10 attendees per facility. No RSVP required!!
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CONSOLIDATED APPROPRIATIONS ACT (CAA)
The Consolidated Appropriations Act (CAA) COVID-19 relief bill provided important COVID-19 related relief for physicians during the pandemic. CAA also impacts the medical provider community with important, new provisions effective January 1, 2022. The bill is available here.
The AMA published a “Summary of Select Provisions” here which includes information pertaining to the No Surprises Act (Page 8). This act protects patients from surprise medical bills when they receive unanticipated out-of-network care in emergency and non-emergency settings, or out-of-network air ambulance services.
AMA’s Summary dives into HR133 Provider Directories and its impact on providers as well as insurance plans (Page 10). IPN will comply with the following provisions on behalf of its network Payors:
- Quarterly provider demographic verifications will be required.
- In addition to name, address, phone number and specialty, directories will begin to reflect an office email address and/or website address.
- Office email and website addresses will begin to be reported in weekly demographic updates to Payors for their directory accuracy requirements.
Providers and facilities must ensure timely notification of directory information and must respond to data verifications to avoid being removed from directories. If a patient relies on incorrect directory information, there are reimbursement penalties and a requirement to pay interest on a patient’s overpayment.
More information will be sent as IPN gears up for compliance by January 1, 2022.
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RUN-OUT REPRICING
Click here to see a list of terminated groups for which IPN is processing run-out claims. Be sure to submit claims before the run-out period ends!
For additional information about the terminated groups, contact the payor listed on the patient's ID card.
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Prior Announcements
you may have missed!
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CIGNA MOVING TO DIRECT CONTRACTING
Cigna and IPN will conclude the network agreement effective June 30, 2022. Cigna has begun contacting some IPN providers regarding efforts for direct contracts and will, eventually, establish a Cigna network in Idaho.
Please be patient as Cigna develops a contracting team. Each office will be contacted in plenty of time to expect a smooth transition for Cigna patients.
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MODA HEALTH - PARTNERSHIP CHANGE
For the past 11 years, IPN and Moda Health (Moda) have worked closely together to meet the
needs of commercial members residing in Eastern Oregon. After much consideration, Moda has
made the decision to transition to a direct contracting relationship with providers. Moda and IPN will terminate their relationship effective September 30, 2021. Moda will be reaching out by mail to eligible IPN providers in the following counties to begin the direct contracting process: Ada, Adams, Canyon, Gem, Idaho, Owyhee, Payette and Washington.
Providers outside these counties will become out of network for Moda patients. For more
information, or to contact Moda, see the attached FAQs
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PHYSICIAN ASSISTANT COLLABORATION LAW
The Idaho Board of Medicine (IDBOM) recently announced Idaho Senate Bill #1093, effective July 1, 2021, which delineates changes in the regulation of the practice of physician assistants (PA’s) and their supervising physicians. The major change involves the removal of the requirement for PA’s to have a supervising physician and replacing that with a collaborative practice agreement (CPA).
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TELEHEALTH POLICY
In order to provide telehealth services to an IPN member, a practitioner must be licensed in, reside in, and provide a physical address or PO Box for billing and other correspondence in, the state of Idaho. Mental health practitioners will be listed in the directory as TELEHEALTH ONLY as their 'address' in IPN reports and in the IPN Directory. All other practitioners will not be listed in the directory.
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PACIFICSOURCE COMMUNICATION UPDATES
COVID-19
General Information
CIGNA COMMUNICATION UPDATES
COVID-19
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Read Cigna's interim billing guidelines and FAQs here.
Network News
Policy & Reimbursement Updates
Cigna routinely reviews coverage, reimbursement, and administrative policies for potential updates. In that review, Cigna takes into consideration one or more of the following: Evidence-based medicine (EBM), professional society recommendations, Centers for Medicare & Medicaid Services (CMS) guidance, industry standards, and our other existing policies.
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Diagnosis related group (DRG) readmissions: Cigna will implement a new reimbursement policy, DRG Readmissions (R35), to update the way claims are processed for inpatient readmissions to the same hospital within 72 hours of discharge. Cigna will review an acute hospital readmission to determine whether it was clinically related to the initial admission. The new policy only applies to participating hospitals with diagnosis related group (DRG) contracts and is effective for claims with a discharge date on or after October 18, 2021.
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Level of care management for spinal procedures: Effective for dates of service on or after October 1, 2021, Cigna will manage the level of care (LOC) for Current Procedural Terminology (CPT®) codes 22558, 22612, 22600, 22630, 22633, and 22856 to encourage redirection from inpatient to outpatient (up to 23 hours) stays. Consideration of coverage for an inpatient stay will be based on medical necessity using MCG. Note: these codes already require precertification for medical necessity.
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Outpatient facility blood draw and venipuncture: Effective for claims processed on or after September 12, 2021, Cigna will administratively deny claims submitted with Current Procedural Terminology (CPT®) codes 36400, 36405, 36406, 36410, 36415, 36416, 36591, and 36592 because reimbursement for these routine services is included in the facility payment. Denials will include administrative appeal rights. The Facility Routine Services, Supplies, and Equipment (R12) reimbursement policy will be updated to reflect this change.
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Venipuncture billed with CPT code 36415: Effective for claims processed on or after October 16, 2021, Cigna will administratively deny claims submitted with Current Procedural Terminology (CPT®) code 36415 for venipuncture as incidental and not separately reimbursable when billed with certain laboratory codes by the same provider, for the same patient, on the same day. Denials will include administrative appeal rights.
For more information about reimbursement policies, log in to the Cigna for Health Care Professionals website (CignaforHCP.com) > Resources > Reimbursement and Payment Policies > Reimbursement and Modifier Policies > Reimbursement Policies.
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Paraprosdokians are figures of speech in which the latter part of a sentence or phrase is surprising or unexpected and frequently humorous. Here are some fun ones that may sound familiar....
- Where there's a will, I want to be in it.
- If I agreed with you, we'd both be wrong.
- We never really grow up -- we only learn how to act in public.
- Knowledge, is knowing a tomato is a fruit. Wisdom is not putting it in a fruit salad.
- To steal ideas from one person is plagiarism. To steal from many is research.
- I didn't say it was your fault, I said I was blaming you.
- In filling out an application, where it says, "In case of an emergency, notify..." I answer "a doctor."
- You do not need a parachute to skydive. You only need a parachute to skydive twice.
- I used to be indecisive, but now I'm not so sure.
- I'm supposed to respect my elders, but it's getting harder and harder for me to find someone older than me.
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p: 866.476.1076 | f: 208.433.4605 | e: ipn@ipnmd.com
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