Showing posts from November, 2021

Surprise Billing Regulation a Gift to Payers, Blow to Providers

Healthcare industry groups representing providers are upset with the latest surprise billing regulation detailing the independent dispute resolution process. The American Medical Association (AMA) is calling the latest in a series of surprise billing regulations “an undeserved gift to the insurance industry that will reduce [healthcare] options for patients.” The statement comes as the Biden-Harris Administration seeks to button up implementation of the No Surprises Act by the end of the year. The Act prohibits surprise medical billing in most situations by making it illegal for providers to bills patients more than the in-network cost-sharing amount for care. The latest regulation seeking to implement the ban on surprise billing detailed the independent despite resolution (IDR) process by which payers and providers will settle reimbursement rates for out-of-network care that would have resulted in a surprise bill for patients. The regulation released late last week included details,

AMA Issues CPT Codes for Pediatric Doses of Pfizer COVID-19 Vaccine

To prepare for potential FDA authorization, AMA has released new CPT codes for pediatric doses of the Pfizer COVID-19 vaccine. he American Medical Association (AMA) has issued new Current Procedural Terminology (CPT) codes for pediatric doses of the Pfizer COVID-19 vaccine. In September 2021, Pfizer and BioNTech shared the results of a Phase 2/3 clinical trial in which two doses of the vaccine elicited a strong immune response in children ages 5 to 11. Following the trial, the companies submitted the data to the Food and Drug Administration (FDA). Pfizer recently announced that they have submitted a formal request to the FDA for emergency use authorization of their COVID-19 vaccine in children ages 5 to 11. In August 2021, the FDA granted full approval of the Pfizer-BioNTech vaccine for individuals 16 and older. The AMA updated the COVID-19 vaccine CPT codes to ensure preparedness if the FDA approves Pfizer’s two-dose pediatric vaccine. The early publication may help healthcare pr