2016 Medicare Tier Pricing/ Other Insurances

alician

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I am trying to find out what insurances have decided to follow CMS and their Tier Pricing for 2016? I have spent the past few days contacting insurances, however most of them are either clueless, or just tell me that they're not making any changes "as of yet"

After a nightmare in 2015 with identifying payers using CMS or AMA codes, I'm trying to get a head start on this. Has anyone had any luck getting information out of any of the insurances?

Thank you in advance!!
 

metzger130

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I am having the same issue. We have been looking for fee schedules for Medicaid for different states and none of them seem to have updated it yet. They still have all the G codes valid. I imagine if they were using the G codes they will go to the single G code but would like to know for sure before we start billing everything out. Also tried to look at Cigna and Humana and nothing is up about what they want for this year.
 

CodingKing

True Blue
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I work for a smaller carrier and we are still deciding. We have always accepted both AMA and CMS even for Medicare Advantage but I've proposed changing it to CMS only across the board.
 

alician

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Thank you all for your replies! It's nice to know I'm not the only one struggling. We've gotten confirmation from some Anthem payors that they're moving, but everyone else is saying that there are no changes as of yet - which leads me to believe they are still deciding and won't move until 4/1 if they decide to.

I appreciate the feedback!

Alicia
 

metzger130

Networker
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So for all the insurance companies that haven't decided yet, how are we supposed to bill them? Do we bill them with the 2015 codes or will they be denied? I ask of course because our physicians want to get paid for this and we want to make sure that we bill these out correctly to get paid.
 

Walker22

True Blue
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So for all the insurance companies that haven't decided yet, how are we supposed to bill them? Do we bill them with the 2015 codes or will they be denied? I ask of course because our physicians want to get paid for this and we want to make sure that we bill these out correctly to get paid.
If you were billing using the 803xx codes in 2015, I would continue to do that (unless you know that the insurance has switched to G codes). If you were billing G codes in 2015, and the payers policy has not been updated for 2016, I would assume that they will switch to the 2016 tiered G codes. I would NOT bill the expired 2015 G codes to anyone unless they expressly ask you to. If you follow these guidelines and then receive a code-related denial, you can switch to the other system, or ask the payer for direction. Alternately, you can hold claims until you know for sure how to bill, but this is not always something the physician is willing to do.
 

alician

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Billing Insurance companies

That's what we've decided to do. All the payers that we were bill 803 codes to, we are continuing to do that. Then, anyone we get coding denials from, we will go from there. It's frustrating and not very efficient, but we don't have much of a choice.
 
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