Becker's Hospital Review

43 CFO / FINANCE Oscar Health to get $375M infusion from Alphabet By Morgan Haefner G oogle parent company Alphabet plans to invest $375 million in Os- car Health, according to Wired. Alphabet, an early investor in Oscar through its Capital G venture capital fund and its healthcare segment Veri- ly, now owns about 10 percent of Os- car, Wired reports. In addition to the investment, Salar Kamangar, former You- Tube CEO and one of Google's first em- ployees, will join Oscar's board. The investment will aid Oscar in expand- ing its technology, membership, markets and new business lines including Medi- care Advantage in 2020. Mario Schlosser, co-founder and CEO of Oscar, said in a prepared statement: "Os- car will accelerate the pursuit of its mis- sion: to make our healthcare system work for consumers. We will continue to build a member experience that lowers costs and improves care, and to bring Oscar to more people." n AMA releases 335 code changes for 2019 By Kelly Gooch T he American Medical Association has released the 2019 Current Procedural Terminology code set. The code set was released Aug. 31, and the AMA announced the release Sept. 5. Here are six things to know: 1. The new code set consists of 335 code changes. 2. Code changes include three new remote patient monitoring codes, as well as two new interprofessional internet consultation codes that reflect the key role non-verbal communication technology plays in care coordina- tion between a consulting and treating physicians, according to the AMA. 3. The association said codes would be revised next year for skin biopsy, fine needle aspiration biopsy and adaptive behavior analysis. 4. There are also coding changes related to central nervous system assess- ments, including psychological and neuropsychological testing. 5. AMA President Barbara McAneny, MD, said the coding changes reflect "new technological and scientific advancements available to mainstream clinical practice, and ensure the code set can fulfill its trusted role as the health system's common language for reporting contemporary medical procedures." 6. The 2019 CPT code set was developed with input from physicians, med- ical specialty societies and others in the healthcare community. It is oper- ational Jan. 1. n BCBS of Texas to stop reimbursing nonemergent ER visits By Julie Spitzer B lue Cross and Blue Shield of Texas, as of Aug. 6, no longer pays for out- of-network emergency room visits in which the insurer determines the patient should have sought treatment elsewhere, ac- cording to the Houston Chronicle. Under the new policy, initially announced in April, a medical director hired by the insurer will review claims aer the ER visit and de- termine the reason a patient opted for the ER and if they could have received treatment at a less expensive clinic. BCBS also will look for over-treatment. e policy is expected to affect roughly 500,000 BCBS of Texas members with health maintenance organization plans. "We have, quite frankly, identified quite a bit of fraud, waste and abuse that happens with- in the context of some of these treatments at some of these facilities," Robert Morrow, MD, president of the Houston and southeast Tex- as office of BCBS of Texas, told the Houston Chronicle in a May interview. e policy was slated to roll out June 4, but numerous complaints from the public and physicians forced it to undergo a 60-day re- view. However, the insurer and the Texas De- partment of Insurance OK'd the controversial measure in early August. TDI said it approved the policy because a physician would conduct the claims reviews and before a denial is issued, physicians could debate their patients' treatment plans with the insurer's physician. Consumers can also appeal the decision to an independent re- view organization, according to the Houston Chronicle. Others disagree, calling the policy "intimidat- ing" and "anti-patient." Rhonda Sandel, CEO of the freestanding ER chain Texas Emergen- cy Care Center, told the publication the in- surer's motive behind the policy is to "drive down the use of ER care [regardless of need] and to increase the profits of Texas' largest in- surance provider at the expense of everyday Texans and their medical providers." Anthem, aer launching a similar policy in multiple states, has faced harsh criticism and numerous lawsuits. A recent report from Sen. Claire McCaskill, D-Mo., found the insurer denied 12,200 claims from members in three states during the second half of 2017 on the grounds the ER visits were "avoidable." How- ever, when patients challenged the denials, Anthem proceeded to reverse itself and pay the claims most of the time. n

• Cover