Payer Pulse
Actionable payer policy intelligence for hospitals, health systems, physician organizations and revenue cycle leaders across the Kansas City metro.
Current Issue
Stay informed on significant payer policy changes, coding updates, reimbursement risks, compliance considerations and contracting developments.
Key Takeaways
- Aetna treatment room reimbursement changes
- UnitedHealthcare Medicare Advantage referral requirements
- Blue KC recovery room billing updates
- Remote Patient Monitoring policy restrictions
- Medicaid and Medicare compliance updates
Top Priority Action Items
- ✅ Review referral workflows for Medicare Advantage patients.
- ✅ Ensure ICD-10 diagnosis code requirements are met for MO HealthNet pharmacy claims.
- ✅ Update billing systems for evolving Medicare and Medicaid coding requirements.
- ✅ Assess reimbursement impacts from payer policy revisions.
- ✅ Evaluate opportunities to challenge payer policies that conflict with CPT or CMS guidance.
Hot Topics This Quarter
-
OB Coding Overhaul (2027)
Preparing for the elimination of global maternity billing -
Remote Patient Monitoring
Payer coverage limitations and reimbursement implications -
Payer Policy Challenges
Emerging policies that may conflict with CPT or CMS guidance.
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