New and Updated Reimbursement Policies

EmblemHealth is adding one new reimbursement policy and has updated several policies listed below. 

New: Facility Transfer – (Medicare/Medicaid)

In our continued efforts to provide transparency regarding our reimbursement practices, EmblemHealth has established a formal policy with payment guidelines for transfers from one inpatient acute care hospital to another for related care and for emergency room transfers between outpatient facilities.

Updated: The following reimbursement policies have been updated. See revision histories for effective dates and applicable changes:

• Bundled Services (Commercial and Medicare) 
• Coding Edits Policy (Commercial, Medicare, and Medicaid) 
• Preventive Care Services Commercial 
• Telehealth/Virtual Care Services 
• Radiology Cardiology Ultrasound Bundling Rules (Administered by EviCore) 
• Radiology Cardiology Ultrasound Correct Coding Rules (Administered by EviCore)
• Radiology Cardiology Ultrasound Frequency Rules (Administered by EviCore) 
• Radiopharmaceuticals and Contrast Agents (Administered by EviCore)