Updated Topics

The Handbook is updated quarterly and all topics in the Handbook are reviewed annually to be sure the information provided is relevant, accurate, and current. Below are examples of some of the topics updated during 2019.

LEGISLATIVE TOPICS

COVID-19 – Information added addressing the provisions and on-going changes to the pandemic-related legislation affecting claim processing.
ERISA – Updated with extension of timeframe requirements for timely filing and deadlines for required notices and disclosures due to COVID-19 pandemic legislation.
Timeline of Federal Benefits Legislation – Updated with ACA reforms effective in 2019.
The Family and Medical Leave Act of 1993 – Information on the Emergency Paid Sick Leave Act and the Emergency Family and Medical Leave Expansion Act was added.
Medicare - 2020 premiums, deductible and copayments were updated. Information on the requirements under Section 4002 of the SUPPORT for Patients and Communities act was added. Information on changes in response to the COVID-19 pandemic was added.
Affordable Care Act Overview – information added on the repeal of the medical device excise tax, the repeal of the health insurance provider fee and the delayed implementation of the Cadillac tax. Information added on the impact of COVID-19 pandemic legislation.
Affordable Care Act and Lifetime/Annual Limits – Updated with the 2020 and 2021 cost sharing limits for non-grandfathered plans.
Affordable Care Act and Preventive Care – Updated with HRSA-supported Women’s Preventive Service Guidelines and the coverage of COVID-19 testing, treatment and vaccines.
Gender Reassignment – Updated with information on recent court cases recognizing that the non-discrimination provision of the ACA prohibits discrimination on the basis of gender identity.
Regulation of Insured and Self-Insured Health Insurance – Updated with additional information on surprise bill laws.
State Assessments on Health Related Claims - Updated with current assessment information by state.
Americans with Disabilities Act of 1990/Effect on Health Plans – Information added on the interaction of the ADA with COVID-19 pandemic legislation.
COBRA – Information added on extended timeframes due to the COVID-19 pandemic legislation.
Product Liability – Additional medications and devices involved in lawsuits were added.
Flexible Benefits Administration - Maximum HSA contribution amounts and HDHP minimum deductible and out of pocket limits for 2020 was updated. Information added on the impact of the CARES Act.
Qualified Medical Child Support Order – Information on the revision of the NMSN Part A form was added.
Privacy and Confidentiality – Information on the impact of COVID-19 on the sharing of information during an outbreak of infectious disease.
Health Insurance Portability and Accountability Act of 1996 – Information on the extension of timeframes for special enrollment under the COVID-19 pandemic legislation was added.
Health Plan Compliance Checklists – Information on the COVID-19 pandemic legislation compliance extensions was added.
State Assessments on Health Related Claims – Updated assessment amounts by state were added.

 

PROCEDURAL TOPICS

Coding & Billing - Updated with information the latest release of the CPT-4 and CDT-2020.
Prescription Drugs – Information on potentially excluded drugs and FDA-approved biosimilar drugs was updated.
Eligibility Overview – Information added on the impact of COVID-19 pandemic legislation on eligibility provisions.
Occupational, Physical and Speech Therapy – Updated with 2020 threshold amounts for use with the KX modifier.
STD - Other Disability Income Sources - Disability benefits by state were updated.
STD Benefit Taxation – The Social Security taxable wage base was updated.
Dental Plan Overview – Procedures requiring submission of X-rays or periodontal charting were updated.
Dental Topics – Information on infection control procedure coverage as a result of the COVID-19 pandemic. Additional covered and non-covered services were added.

 

MEDICAL TOPICS

Ambulance/Transportation Services – Updated with information on Medicare coverage for medically necessary emergency and non-emergency ground ambulance transportation during the COVID-19 public health emergency.
Biofeedback – Updated with current coding.
Botulinum Toxin Injections - Updated with additional covered services.
Breast Biopsy Procedures - Updated with additional covered and non-covered services.
Cardiac Rehabilitation Programs - Updated with additional investigational procedures.
Cosmetic Surgery – Updated with legislative issues related to gender transition services.
Eye Surgery - Updated with additional covered and non-covered services.
Fetal Surgery – Updated with additional investigational procedures.
Gender Reassignment - Updated with additional investigational procedures.
Genetic Testing – Updated with additional covered and non-covered services.
Home Oxygen Therapy - Updated with additional covered and non-covered services.
Hyperbaric Oxygen Therapy – Updated with Medicare coverage information.
Lung Volume Reduction Surgery - Updated with additional covered services.
Mental Health – Information added on the impact of coverage of telemedicine services due to COVID-19 pandemic legislation. Information on compliance with MHPAEA related to exclusions of some services treating autism and learning disorders was added.
Nerve Conduction Studies - Updated with additional investigational procedures.
Nutritional Therapy - Updated with additional covered and non-covered services.
Obesity – Link to BMI calculator was added.
Obstructive Sleep Apnea – Updated with Medicare coverage requirements for CPAP therapy and sleep testing procedures and devices.
Prosthetic Devices - Updated with additional covered and non-covered services.
Self-Inflicted Injuries – Maine was added to the list of states with death with dignity statutes.
Skin Lesion Removal - Updated with additional investigational procedures.
Spinal Surgery Procedures – Updated with several additional covered and investigational services.
Substance Abuse – Medicare’s policy for services rendered by an Opioid Treatment Facility was added.
Surgery Payment Guidelines - updated with current Medicare National Physician Fee Schedule Relative Value File information.
Telehealth – Updated with Medicare’s covered services and the impact of the COVID-19 pandemic legislation on telehealth claims.
Vaccines/Immunizations - updated with current information on the CDC’s Recommended Immunizations Schedules.
Vision Therapy - Updated with additional covered services.

 

OPERATIONAL TOPICS

Appeals Processing - Updated with information on the extension of timeframes for appeals and external reviews under the COVID-19 pandemic legislation.
Surgery Payment Guidelines - The Medicare National Physician Fee Schedule Relative Value File information was updated.
Provider Definitions – Information added on the actions taken to liberalize or waive provider requirements during the COVID-19 public health emergency was added.
Claim System Considerations – Vendor chart was updated.
Claims Cost Containment – Updated on the requirement that hospital pricing be made public.
HIPAA & ACA Standards for EDI – Updated with information on the HHS final rule related to the use of unique health plan identifiers.
Vendor Selection & Monitoring – The list of URAC and NCQA programs was updated.
Pharmacy Benefit Manager Audits – Information on criteria for a PBM contract added.
Organizational Security/Disaster Planning – Updated with additional information on disaster recovery plans.

 

LISTINGS AND DIRECTORIES

CMS Regional Offices - Listing was updated.
Internet Sites – Links were updated.
Organizations in the Insurance Industry – Health Care Administrators Association was added.
Regional Organ Procurement Organizations - updated with current information.
State Dental Board Directory - updated with current information.
State Insurance Department Directory - updated with current information.
State Intoxication Levels – Chart of legislation by state was updated.