Shop talk January 2019

Today I will talk shop. I think I will interject this in-between the big read stuff and just tell you things that are coming up that are causing us a bit of trouble, which happens a lot in the beginning of the year.

In some cases a pension will self-administer plans. We had a couple of very large pension funds give their members options to move to Medicare Advantage plans that are more main stream and the pensions discontinued some of their self-directed type plans. The members got to make these choices back in November. But some of them have things scheduled and no updates on the new plan information until we review.

It’s a good reminder that as you are helping your parents keep track of these things, sit down in November and ask if they received any information or if they are aware of any plan changes happening for the new insurance plans calendar year. Remember a majority will follow January to December, but some will follow different fiscal years.

Secondly – there are a lot of codes (CPT’s) retiring this year. I pretty much am running all my codes through a code checker to see if they have been deleted as of 2019. And then going to another software program to see what the code changes are. This happens for a variety of reason.

One drug for example, Inflixmab, had a temporary J code for 2018. The CPT code was Q0501 (something like that). Drugs get codes that start with ‘J’. The Q code was a temporary code. Now they have changed it to a permanent ‘J’ code. This means that is you have an infusion (a shot or IV drug) that you get on a regular basis, that drug may need an authorization. The auth that is in place is for the old ‘J’ code because you started treatments in 2018. I call the doctors office and request them to update to the new ‘J’ code so it goes through as a clean bill.

There was also a couple other procedure codes that went away. The insurance company will not tell us the replacement code, but they will spend 15 minutes to make absolutely sure (while I am on hold) the code is deleted for 2019. This has caused extra work on several fronts to either get the new CPT or to update authorizations for existing services.

Also, sometimes you will tell one group you changed your insurance plan, but either the hospital or specialist doctors office didn’t get the information. Easy one, you turn 50 and are eligible for the baseline colonoscopy (CPT G0121 or 45378). You gave your doctors office the insurance information. They recommended a specialist or two. You went through and scheduled it in November for January. You update your insurance information with your regular doc, but the specialist who will be taking you on a ‘go-pro’ adventure doesn’t have it. Since the specialist scheduled it – the hospital doesn’t have it either.

Don’t shoot the messenger. Part of this is all the protections set in place to keep your demographic and medical information behind a firewall of sorts. Be impressed that your information can’t easily transfer from one group to another.

That’s my shop talk for today.