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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-013v3 Urine Culture Testing for Bacteria

Bacteriuria is the presence of bacteria in the urine. Urinary tract infections (UTIs) can occur in the urinary system and can be either symptomatic or asymptomatic.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-015v3 Testing for Vector-borne Infections

Arthropod vectors, including mosquitoes, ticks, fleas, and mites, that feed on vertebrate hosts can spread bacteria, protozoa, and viruses during feeding to their susceptible host, resulting in a variety of infections and diseases.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-033v3 Identification of Microorganisms Using Nucleic Acid Probes

Nucleic acid hybridization technologies utilize complementary properties of the DNA double-helix structures to anneal together DNA fragments from different sources.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-045 Biomarkers for Myocardial Infarction and Chronic Heart Failure

Cardiac biomarkers are the biochemical markers released in blood from injured myocardial tissue in both acute and chronic conditions, such as myocardial infarction or heart failure.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-048v2 Testing for Alpha-1 Antitrypsin Deficiency

Alpha 1-antitrypsin deficiency (AATD) is a genetic disease that causes deficient or defective production of the alpha-1 antitrypsin (AAT) protease inhibitor that can affect the lungs, liver, and skin (Stoller, 2022b).

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-030 Salivary Hormone Testing

Testing of saliva has been proposed as a noninvasive method to measure free (unbound to carrier proteins) steroid hormones, including estrogen, progesterone, androgens, and cortisol, for diagnosis of hormonal imbalance and administration of individualized hormone replacement therapy (ACOG & ASRM, 2012).

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-060 Biomarker Testing for Autoimmune Rheumatic Disease

Systemic autoimmune rheumatic diseases (SARDs) are a diverse group of conditions that primarily affect the joints, bones, muscle, and connective tissue (AAFP, 2019).

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-066 Prescription Medication and Illicit Drug Testing in the Outpatient Setting

Abuse of both prescription and illicit drugs is extremely common. Drugs of abuse (DOA) may be defined as “a drug, chemical, or plant product that is known to be misused for recreational purposes,” which can include drugs such as pain relievers that have legitimate prescriptions.

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Provider Alerts - Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Provider-Identified Overpayments

If a provider determines that Healthfirst has overpaid a claim, the provider shall, within 60 days of discovery, send a refund check made out to Healthfirst PHSP, Inc. in the amount of the overpayment. View the provider alert for details.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-080 Colorectal Cancer Screening

Colorectal cancer (CRC) is the term used to describe the development of cancer in the colon or the rectum.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2024
Reimbursement Policy: PO-RE-079 Coronavirus Testing in the Outpatient Setting

Human coronaviruses, first characterized in the 1960s, are named based on the spiked proteins located on their surface.

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Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2023
Reimbursement Policy: PO-RE-074v1 Remote Patient Monitoring

The purpose of this policy is to ensure the Remote Patient Monitoring (RPM) services are reimbursed appropriately and to encourage the use of RPM to improve patient outcomes.

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