Billing Digest - January, 2025

January, 2025

What’s new for 2025?

Each year, the Centers for Medicare and Medicaid Services (CMS) ushers in new rules that impact the healthcare industry in the areas of compliance, coding and reimbursement. To help you prepare for the year ahead, the IPHA Third-Party Billing team will be hosting an Overview of 2025 CMS Final Rule and Medicare Physician Fee Schedule on Wednesday, January 22, 12:00 – 1:00 PM. Presented by Kem Toliver, FACMPE, CPC, CMOM, President and CEO of Medical Revenue Cycle Services (MRCS), this program will provide insight into the key changes in the CMS 2025 Final Rule. Please register for this presentation here.

Medicare Part B Vaccine Administration: CY 2025 Payment Amounts

CMS has announced updates to the Part B payment amounts for CY 2025 preventive vaccine administration for: COVID-19, Flu, Hepatitis B, and Pneumococcal.

The CMS update includes annual increases in the Medicare Economic Index, Geographically-adjusted vaccine administration rates for HCPCS codes G0008, G0009, G0010, 90480, and M0201 and Payment rates for administering Part B preventive vaccines in the patient’s home. For more Information, please see: CY 2025 Physician Fee Schedule final rule, Vaccine Pricing webpage, Preventive Services webpage and Instruction to your Medicare Administrative Contractor (PDF).

New Laws Strengthen Public Health in Illinois

The Illinois Department of Public Health (IDPH) has announced several new laws and rules designed to strengthen the public health system effective January 1, 2025. For more information, please see the IDPH issued summary of New Laws, Rules Impacting Public Health to Take Effect in 2025.

Getting to Zero IL (GTZ) will be hosting a special Community Conversation on Thursday, January 23, 2025, from 12:00 – 1:00 PM CST, to discuss Illinois Department of Insurance Bulletin 2024-18.

This important bulletin eliminates financial and administrative barriers to accessing PrEP and PEP and expands coverage for follow-up care like counseling and side effects management. Learn why this matters, how it impacts our communities, and what it means for our Getting to Zero goals. Leading the conversation will be Timothy Jackson, Senior Director of Policy and Advocacy at AIDS Foundation Chicago, and Meg McElroy, Director of Special Projects at Getting to Zero.

Registration Link: https://tinyurl.com/GTZCommunityConvoPrEPBulletin

The Illinois Association of Medicaid Health Plans (IAMHP) will be presenting the following trainings:

Friday, January 17, 12:00 – 1:00 PM CST, Lunch & Learn webinar, How Medicaid is Changing and Why.
Friday, February 7, 12:00 – 12:45 PM CST, Sip & Refresh webinar, IAMHP Roster Updates.
Friday, February 21, 12:00 – 1:00 PM CST, Lunch & Learn webinar, Billing for Community Mental Health Centers.
Thursday, March 6, 12:00 – 12:45 PM CST, Sip & Refresh webinar, Common Billing Challenges.

This Month's MVR

The Illinois Association of Medicaid Health Plans has published the IAMHP Winter 2024 Newsletter. This valuable resource provides important information about the expanded 1115 Waiver in Illinois. In addition, this issue introduces David Vinkler as IAMHP’s new Vice President of Public Policy and Government Relations. Other topics include a 2024 Annual Conference Recap and Health Plan Stories of Impact.

If you have not already subscribed to receive IAMHP publications, please subscribe here.

Get to Know the Payers – UnitedHealthcare

As one of the largest health insurance companies in Illinois, UnitedHealthcare offers a variety of individual health plans, employer sponsored group health plans, Medicare plans, and more.

If you are not already contracted with UnitedHealthcare, you may join their network at: Join Our Network | UHCprovider.com. Contracted providers can find Resources and tools for providers and health care professionals | UHCprovider.com. Their provider manual can be found here: Care Provider Administrative Guides and Manuals | UHCprovider.com. Please be sure to complete the New Provider Orientation: Onboard Pro Interactive Guide

Register to receive provider notices here: Network News | UHCprovider.com. To find your Network Relations contact information and coverage areas, please visit: Contact us | UHCprovider.com.

For information about interpreter/translator services available to members and providers, please see: Language assistance / nondiscrimination notice | Legal | UnitedHealthcare.

Information about how to verify member eligibility and a link to resources for eligibility verification are here: Eligibility and Referrals | UHCprovider.com. The Claims Quick Start Guide - Electronic Reconsideration Requests provides procedures and contacts for pursuing claim rejections and denials.

For provider training resources and a list of required trainings, please see: Healthcare Professional Education and Training | UHCprovider.com

Information about other provider resources is listed here: UnitedHealthcare Provider Portal resources | UHCprovider.com

Please note, to chat with a health care professional and get real time answers to questions about a wide range of topics such as; Claims, Eligibility and Prior authorization, Credentialing and onboarding, and Technical support, please use the “Chat Now” feature at Contact us | UHCprovider.com.

For Community and State claims-related issues, please contact Provider Services at 866-675-1607 or for Commercial and Medicare Advantage claims-related issues, please contact Provider Services at 877-842-3210.

HFS has recently issued several important Provider Notices:

If you have not already subscribed to receive email notifications from HFS when new Provider Notices are posted, you may subscribe here. To learn more about the many helpful resources available to healthcare providers, please visit the HFS Provider website.

If you have any questions or suggestions for topics that you would like to see covered in future issues of the IPHA Billing Digest, please email your suggestions and/or requests to insurancebilling@ipha.com.

Thank you!