July 2020

Minnesota AUC Newsletter

July 2020

Revised 837P, 837I MUCG to be Announced as Proposed Rules July 27, 2020

In May the AUC approved proposed revisions to the 837 Professional and 837 Institutional Minnesota Uniform Companion Guides (MUCG), including major revisions to a lengthy appendix with medical coding instructions. The revisions were proposed to streamline and simplify the coding appendix and to ensure that all other MUCG information was current and accurate.

Per state statute, the revised MUCG will be announced as proposed rules in the Minnesota State Register on July 27, 2020. The public will have 30 days to comment on the proposed rules. The State Register announcement and instructions for submitting public comments will be posted on the AUC website and will also be disseminated via the primary AUC list-serve ("Gov.delivery" list). Please contact us if you have questions.

AUC Meetings Canceled Through End of July; Will Resume in August if Possible

Due to the competing demands of responding to the COVID-19 pandemic, the AUC meetings scheduled for June and July – including the Operations Committee and all Technical Advisory Group (TAG) meetings -- were canceled. Meetings and related AUC activities will resume in August if possible. Please check the AUC calendar webpage for further information.

COVID-19 Coding and Billing Information/Updates/Resources on AUC Website

As the COVID-19 outbreak proceeds at a dizzying pace, so to do updates and instructions for COVID-related billing and coding. A number of updates, tips, and resources are available on the AUC Coronavirus (COVID-19) Updates webpage.

NCVHS Seeking Comments by July 24 Regarding a Proposed Set of Prior Authorization and Connectivity Operating Rules

CAQH-CORE, the recognized operating rule authoring organization, has proposed a new set of operating rules with provisions regarding data content, infrastructure, and connectivity for the exchange of the X12/005010X217 Health Care Services Review – Request for Review and Response (278).

The National Committee on Vital and Health Statistics (NCVHS) is gathering public comments through July 24 to aid in making recommendations regarding the proposed rules to the federal Secretary of Health and Human Services. For more information, see the NCVHS request for public comments.

CMS Seeking Input, Participation in Prototype "Documentation Requirement Lookup Service (DRLS)" to Reduce Burdens of Prior Authorization

  • DRLS goals: Reduce provider burden; Reduce improper payments and appeals; Improve "provider to payer" information exchange.

  • All payers encouraged to align with CMS

The federal Centers for Medicare & Medicaid Services recently announced that it is actively seeking industry input and participation in the development of a Medicare Fee for Service (FFS) Documentation Requirement Lookup Service (DRLS) prototype. The prototype will be made accessible to participants in a pilot, and will be populated with: a list of items/services for which prior authorization is required; and the documentation requirements for Oxygen and Continuous Positive Airway Pressure (CPAP) devices.

Future versions of the DRLS will enable providers to discover Medicare FFS prior authorization and documentation requirements at the time of service, within their electronic health record (EHR) or integrated practice management system. The DRLS may be used to answer questions such as:

  • Is prior authorization required by Medicare FFS for the item or service for which I’m about to refer my patient?

  • Does Medicare FFS have documentation requirements for the item I’m about to order for my patient?

In developing the prototype, CMS is participating in two industry workgroups to promote development of standards that will support the Medicare FFS DRLS: the HL7 hosted private sector “Da Vinci” project; and the federal Office of the National Coordinator for Health Information Technology (ONC) Payer + Provider (P2) Fast Healthcare Interoperability Resource (FHIR) Taskforce. At the same time, CMS is preparing to support pilots testing the information exchanges for Medicare FFS programs and possibly coordinate pilots with volunteer participants to verify and test the new FHIR-based solutions.

CMS is encouraging all payers to follow CMS’s example and align with the Da Vinci project to: (1) develop a similar lookup service; (2) populate it with their list of items/services for which prior authorization is required; and (3) populate it with the documentation rules for at least Oxygen and CPAP.

By taking this step, health plans can join CMS in helping to build an ecosystem that will allow providers to connect their EHRs or integrated practice management systems and establish efficient work flows with up-to-date information on: 1) which items and services require prior authorization; and 2) what the documentation requirements are for various items and services under that patient’s current plan enrollment.

For more information, see the CMS DRLS webpage.

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Updated Wednesday, 15-Jul-2020 12:16:30 CDT