XIFIN e-Newsletter Archives
July 1, 2008
CMS:
Quarterly Updates to CCI Edits
Clinical Laboratory Fee Schedule - New Waived Tests
New CLIA Waived Tests
Date of Service (DOS) for Clinical Laboratory and Pathology Specimens
Clinical Laboratory Fee Schedule - Medicare Travel Allowance Fees for Collection of Specimens
Changes to the Laboratory National Coverage Determination (NCD) Edit Software for July 2008
Reminder: Medicare Provides Coverage of Daibetes Screening Tests
CMS Actions on Processing of Physician Claims on or after July 1, 2008
California Medi-Cal
CPT -4 Codes 88147 and 88148 Billing Restrictions Update
Pathology Tests Billing Update
Radiology and Laboratory Modifier Update
New Age Restrictions for Papillomavirus Testing
Additional Budget Information
New York State Medicaid
Medicaid Now Reimbursing for Viral Tropism Laboratory
May 1, 2008
Medicaid:
California - Medi-Cal
Pathology Codes Reminder
Trofile is a New Medi-Cal Benefit
AmniSure Test Not a Medi-Cal Benefit
CPT-4 Codes 80061 and 83721
Billing Requirement Update for CPT-4 code 88141
Family PACT Billing Update for CPT-4 Code 88141
Reminder: End-Dating of Medi-Cal Provider Numbers
CMS
CMS-CR 5913: New CLIA Waived Tests
RARC and CARC Update
Collapsing Medicare Provider Transaction Access Numbers (PTANs)
(HCPCS) Codes Subject to and Excluded from (CLIA) Edits
REVISEDABN NOTICE
Clinical Laboratory Fee Schedule
Mar 01, 2008
CMS
Clinical Trial Claims
COBA Medigap Claim-Based Crossover Process
Legacy Provider IDs Prohibited on Claims
Medicare Clinical Laboratory Services Competitive Bidding Demonstration Implemented
Modifiers Added for Clinical Trials
New Automated Test
NPI Critical Dates
Referred or Ordered Services Denied
TC Changes of Physician Pathology Services
Jan 28, 2008
CMS
Medicare Physician Fee Schedule
2008 Clinical Lab Fee Schedule
Travel Fee Schedule
California Medi–Cal
Procedure Code 87210 Benefit Update
Tricare:
Procedure Codes 87620-87622 Update
Dec 12, 2007
AMA
Alternative Lab Platform Testing
New and Deleted Codes
CMS
Electronic e-Mail Update Service
Fee-For-Service Providers
Key Medicare NPI Implementation Dates
Medicare Administrative Contractors
MUEs Questions & Answers
RARC and CARC Update
WPS
The Next Step Towards Full NPI Implementation
California — Medi-Cal:
Effective Date Change for CPT Code 82607
Important NPI Dual-Use Period Changes
Nov 01, 2007
CMS
Important NPI Enrollment Information
NPI Final Implementation
New FDA Waived Tests Under CLIA
RARC amd CARC Update
California — Medi-Cal:
2008 ICD-9-CM Code Updates Delayed
Effective Date Correction for New Maternal Serum Screen Benefit
Missouri — Medicaid:
Missouri Medicaid Renamed
Oct 01, 2007
CMS
Quarterly Update to CCI Edits
Required Reporting of NPI
Report Both NPI and Medicare Legacy Identifier On Claims
Medigap Crossover Claims
Availability of UPIN Registry Website
California — Medi-Cal:
HCFA 1550 & UB-92 Claim Forms Cutoff Date Extension
Ferritin Blood Test Diagnosis Restrictions
Billing Restrictions
Fetal Fibronection Testing
New Maternal Serum Screen Benefit
Presemptive Eligibility Program Benefits
Sep 04, 2007
CMS
Pathology Services Performed upon Admit or Discharge
Date of Service for Laboratory Specimens
Aug 06, 2007
CMS
Claim Adjustment Reason Codes and Remittance Advice Remark Codes
Top 10 Duplicate Claim Submitters by Specialty
New CLIA Waived Tests
NPPES Errors, Using the NPI on Medicare Claims
California — Midi-Cal
2007 CPT-4 Codes Adopted
Diagnosis Restrictions for Gonadotropin Follicle Stimulating and Luteinizing Hormones
The Family PACT
New 1500 Claim Form
Jul 02, 2007
CMS
New Diagnosis Codes
Deadline For Data Updates to NPPES
Dissemination of NPPES Data
NHIC — California
Flow Cetometry and Immonuocytochemistry
Quarterly Certs Review
California — Midi-Cal
2007 CPT-4/HCPCS Updates
Medi-Cal Transmitions to CMS-1500 form and NPI
Nonspecific ICD-9-CM Codes Not Billable
Jun 07, 2007
CMS
Data Dissemination Notice
Discontinuance of the UPIN
Jurisdictional Pricing Rules
Modifier “–59”
Paper Claims
Provider Authorization
Rejection Form CMS-1500
Stage 3 NPI Changes
Transitioning the Medigap
UB–92 Replacement
Empire — New York
Retired LCDs
May 01, 2007
CMS
CWF Update
NPI Contingency
NPI
Submission Requirements
Medi–Cal — California
Presumptive Eligibility
NHIC — California
LCD Revision
Apr 02, 2007
CMS
Acceptance Period Extended
Invalid Overpayments
Correction to CR5404: New Waived Tests
Medically Unlikely Edits
Quarterly CCI Update
New Waived Tests
NCD Changes
NHIC — California
Claims Adjudication: Error for “10” Units Corrected
Mar 01, 2007
CMS
ABN Revision
Invalid Overpayments
Processing Dx Codes
RARC & CARC Update
California - Medi–cal
B12 Policy Correction
Non-Specific Dx
Policy Change
Jan 12, 2007
CMS
Tax Relief and Health Care Act of 2006
CCI Edits
Lab Competitive Bidding
Lab Fee Schedule
Medically Unlikely Edits
NHIC - California
Revised LCD
California - Medi–cal
Laboratory Chemistry Procedures Update
Vitamin B12 Reimbursement Policy Update
Nov 30, 2006
CMS
2007 Codes for Lab and Pathology
CWF Duplicate Claim Edit
NCD Changes
Processing Dx Codes
Oct 29, 2006
CMS
Colorectal Cancer Screening
NPI
Sep 29, 2006
CMS
CCI Update
Competitive Bidding
NCD
New Waived Tests
NPI Requirements
Pathology TC
California – Medi–Cal
Flow Cytometry Code
Genetic Testing
Revised Reporting for Pap Smear Tests
Illinois – Medicaid
Perinatal HIV Testing
Aug 31, 2006
CMS
Form CMS-1500 (8/05)
9-Day Payment Hold
Medically Unlikely Edits
RARC & CARC Updates
California – Medi–Cal
Frequency Restriction
NPI Registration
Jul 21, 2006
CMS
9-Day Payment Hold
CCI
CHCT
Form CMS-1500 (8/05)
NCD
New Waived Test
California – Medi–Cal
A1C Testing
Family PACT
Flow Cytometry
Morphometric Analysis
RAD Code 10
Jun 02, 2006
CMS
Electronic File Interchange
New Waived Tests
May 01, 2006
CMS
Revised 1500 Claim Form
California: Medi-Cal
Lab Service Frequency Limits
Apr 03, 2006
CMS
CLIA Waived Tests
Denial of Claims
ESRD Benefits
NCD Update
Paper Remittances
Surrogate UPINs
Feb 27, 2006
CMS
2006 Medicare Physician Fee Schedule
Change Payment Floor Date for Paper Claims
Hold on Medicare Payments
NPI
NHIC
MSP Voluntary Refunds
California - Medi-Cal
DOS Change for Prenatal Cystic Fibrosis Screening
Jan 27, 2006
CMS
Date of Service Policy For Lab Tests
NCDs Update Changes
Revision on Transition Period to NPI
Redefined Type of Bill
Discontinuation of Surrogate UPINs
New Waived Tests
2006 Travel Fees Changes
NHIC
Retired LCDs
Telephone Redeterminations
>California - Medi-Cal
2006 CPT-4/HCPCS Code Update Reminder
Lab Procedure Benefit Update
Diagnostic Radiology Policy Update
Prenatal Cystic Fibrosis Screening Policy Clarification
Presumptive Eligibility Change of Address
Human Papillomavirus DNA or RNA Test Restrictions
Dec 01,2005
CMS
2006 Annual Clinical Lab Fee Schedule
New Website
Billing for Blood and Blood Products
National Provider Identifier CMS Website
Remittance Advice Update
Full Replacement of and Rescinding CR3504
New CMS Procedures
California - NHIC
Controversy Requirements For ALJ
California - Medi-Cal
CMSP Transfer to Blue Cross
Provider Manual Updated
Test Restrictions Update
Suspended and Ineligible Provider List
Oct 25, 2005
CMS
Coding Analyses for Labs
Expansion of Duplicate Claim Edit
National Modifier and Condition Code to Identify Disaster Related Claims
NPI
Proposed Rule for Claims Attachments Published
Remittance Advice Remark Code and Claim Adjustment Reason Code Update
California Medicare-United Government Services
Customer Service and Claims Workloads
>Kansas, Nebraska and Northwest Missouri-Medicare
Enforcement of Mandatory Electronic Submission of Medicare Claims
Kansas Medicare
Medicare Secondary Payer
California Medi-Cal
Claims Appeal Status Available
Linking Paper Attachments to POS Device Health Care Claims
New BIC Issuance Complete
Request for Application Cancelled
Sep 12, 2005
XIFIN Lab Resources Travel Fee Calculator
CMS
CCI Updates
Quarterly Update to CCI edits
Carrier Manual Update
CWF Update
New FDA Waived Tests
Modifiers to AMCC Tests Submitted for ESRD Patients
Changes to NCDs
Negotiated Laboratory NCDs
Medicare Physicians Fee Schedule Update
Aug 01, 2005
CMS
Annual Update of ICD-9, Ninth Revision
Remittance Advice Remark Code & Claim Adjustment Reason Code Update
California - Medi-cal
Billing Requirement for Laboratory Procedures
Jun 24, 2005
CMS
Change in the First Level of Appeal: Redeterminations
National Provider Identifier
New Remittance Advice for Referred Duplicate Services
Temporary Change to Carrier Jurisdictional Pricing Rule for Referred Services
California - Medi-Cal
Benefits Identification Card Number Update
2005 CPT-4/HCPCS Updates
May 27, 2005
CMS
Matching Claims Data to Beneficiary Records
National Provider Identifier
NCD Edits
Reflexed Manual Differentials
Travel Fee Update
California - Medicare: NHIC
Draft LCD for Allergy Testing
California - Medi-Cal
Children's Treatment Program - Eligibility and Claim Submission
QW Modifier
Apr 22, 2005
CMS
Quarterly Update to CCI Edits, Version 11.1
NCD Revisions
New Waived Test
National Provider Identifier Enumerator
Update to Submission of Purchased Services
OIG
Exclusions & Reinstatements
Empire Medicare Services
Multi-Carrier System
Updated LCDs
Blue Cross Blue Shield of Kansas
Updated LCDs
California - Medi-Cal
Sputum Procedure Billing and Rate Update
Florida - Medicaid
10% Reduction in Independent Lab Fees
Mar 11, 2005
CMS
Quarterly Update to CCI Edits
Change In Claim Edits
Update on New Diabetes Screening Coverage
Frequency Edits Being Incorporated into CCIs and OCEs
Extend Time for Good Cause
Independent Lab Billing for TC of Pathology Services for Hospital Patients
Interest Payment on Clean Claims Not Paid Timely
Payment for Referred Laboratory Automated Multi-Channel Chemistry Tests
New Remittance Advice Message for Referred Services
Updated Edits for Screening Pap Smears (Q0091)
New Waived Tests
California - Medi-Cal
Chlamydia, Gonorrhea Laboratory Services Updates Rescinded
Prenatal Cystic Fibrosis Screening Policy Correction
New QuantiFERON-TB Blood Test Benefit
ICD-9 Specificity Billing Modification
Billing for Surgical Pathology Procedures Related to Abortions
OIG releases January Exclusions & Reinstatements
Jan 07, 2005
CMS
Cardiovascular Screening Blood Test Guidelines
Diabetes Screen Tests
Duplicate Claim Edit for Referred Lab Services
ESRD 50/50 Rule Implementation
IPPE for New Medicare Enrollees
Changes to the Lab NCD Edits
NHIC - California
(Northern and Southern)
Oncotype DX Test for Breast Cancer Tissue Samples
Reminder to Include ICD-9-CM Diagnosis Codes On Claims
California - Medi-Cal
ICD-9 Specificity Billing Modification
New Medi-Cal Procedure/Drug Code Limitation List
Claims Attachment Reminder
Nov 17, 2004
CMS
2005 Annual Update for Clinical Laboratory Fee Schedule
Beneficiary Signature Requirements
CCI Quarterly Update
New CLIA Waived Tests
ESRD Reimbursement for AutoChems
Remittance Advice Remark Code and Claims Adjustment Reason Code Update
Temporary Change in Carrier Jurisdictional Pricing Rules for Purchased Diagnostic Services
NHIC - California and New England
Claim Corrections
LMRP Updates - California - NHIC
Making Voluntary Refunds to Medicare
Screening for Data
>California - United Government Services Medicare Fiscal Intermediary
New Address For Paper and Adjusted Claims
LMRP Updates
California - Medi-Cal
2004 CPT-4, HCPCS Additional Policy Changes
Prenatal Cystic Fibrosis Screening
New Benefits Identification Cards
New Medi-Cal Benefit: Chest Ultrasound
New Ultrasound Benefit
Positron Emission Tomography Scan Benefit Update
Medicare:
Illinois - Wisconsin Physician Services
WPS 2005 Fee Schedule Correction
Medicare: New York - Empire
LMRP Updates
Sep 24, 2004
CMS
2005 Physician Fee Schedule
CCI Quarter Update - Version 10.3
OCE Quarterly Update
California - NHIC
High Sensitivity C-Reactive Protein
Making Voluntary Refunds to NHIC Medicare
California - Medi-Cal
2004 CPT-4 and HCPCS Updates
Clinical Laboratory Services Request for Application
>Illinois - WPS
Diagnostic Pap Smears
New York - Medicaid
HIPAA Compliance Deadline
New Lab Service
Tennessee - CIGNA
LMRP Updates
Aug 20, 2004
CMS
Discontinuation of MSP Requirement for Hospitals
Duplicate Claims Submissions
Medicare Physician Fee Schedule Update
Process To Resubmit Minor Claim Errors
California - Medicare
High Sensitivity C-Reactive Protein
LMRPs Updated
California Medi-Cal
Electronic Submission of Laboratory Services with Medical Justification
2005 ICD-9-CM Diagnosis Codes - No Implementation Grace Period
Jul 20, 2004
CMS
- Adjudication of Reference Laboratory Service Claims
Appeals = Redeterminations - The Medicare Part B Fee-for Service Appeals Process
ICD-9-CM Update
NCD Update
CCI - Version 10.2
Jun 11, 2004
CMS
- Remittance Advice Remark Code and Claim Adjustment Reason Code Update
May 14, 2004
CMS
- Change To Scheduled Claims Crossover Process
Medicare Claims Processing - Changes to the Laboratory NCD Edit Software for July 2004
Payment of Referral Services - Transmittal 85
Medicaid Illinois
IDPA HIPAA Implementation Status Update and Contingency Plan Information
Apr 12, 2004
CMS
Decision Memo for Urine Culture Bacterial
Medicare NCD Updates
California Medicare - NHIC
Local Modifiers Eliminated - Reminder
WPS - Illinois Medicare
LMRP Information
MPFSDB Fee Changes
California Medi-Cal
Changes Affecting Laboratories
Correction Of Reimbursement Pricing Errors
Benefit Deletion
State Competitive Bidding Initiatives
Florida Medicaid
- RFP for a statewide lab contract
Mar 18, 2004
CMS
CLIA - New Waived Tests
Coordination of Benefits Agreement (COBA)
Elimination of Grace Period for Discontinued Codes
HIPAA - Modified HIPAA Contingency Plan
NCD - Updates
Remittance Advice Remark Codes -
and Claim Adjustment Reason Codes updated
California - NHIC Medicare - Apolipoproteins
Duplicate Billing Denials
New Medical Director for CA
California Medi-Cal
FPACT HPV Testing
New York - EMPIRE Medicare
LCDs
"Reimbursement Issues In Molecular Diagnostics"
Feb 17, 2004
CMS
Medicare Secondary Payer Rules
"CB" Modifier For Dialysis Services
Claim Billing Instructions Revised
90-Day Grace Period Elimination
Lab-to-Lab Referrals
NCD - Laboratory National Coverage Determination - Update
National Provider Identifier (NPI) - Final Rule Published
California Medicare
NHIC - Southern California will use CC to identify when modifiers inconsistent...
New England - updated LMRPs
Medi-Cal - Reimbursement Rates
Jan 09, 2004
CMS
- Medicare Remittance Remark Coding Update
Fecal-Occult Blood Tests (FOBT) - Expanded Coverage
CCI - Changes to Correct Coding Edits, Version 10.0
New York and New Jersey - 2004 Medicare Travel Allowance Fees for Collection of Specimens
Dec 12, 2003
CMS
- 2004 Lab Update Eliminated
Clinical Diagnostic Laboratory Services - GY Modifier
Modifier Billing Reminder
Payment Policy Change
Purchased Services - Payment Limit for Laboratories
Screening Immunoassay-Based FOBTs
Travel Allowance Update
NCD - Changes to the Edit Software
CCI Edits - Quarterly Update Version 10.0
Oct 30, 2003
NHIC - LMRPs pertinent to Cytogenetic Studies
Empire Medicare Services
(New York) - Revised LMRPs
CMS
Transmittal B-03-040, Change Request 2730
Transmittal B-03-045, Change Request 2725
Sep 26, 2003
CMS
coverage policies for diagnostic and screening PSAs
Medicare Diagnosis Requirement
CCI - Changes to Correct Coding Edits, Version 9.3
NCD Coding Changes
Medicare To Accept Non-Compliant HIPAA Transactions
ICD-9-CM Annual Update - Revised
OIG Reviews Lab Pricing Structures
NHIC - Fecal Leukocyte Examination during calendar year 2003
California Medi-Cal - "proposed" Medi-Cal rates are now on line at the DHS lab contracting website effective Oct 1, 2003
Aug 25, 2003
CMS
ICD-9-CM Annual Update
New Tracking Sheet to re-evaluate the inclusion of ICD-9-CM codes 584, 585 and 586
Changes to the Laboratory NCD Edit Software
OIG - release of final inspection report on UPIN database
HIPAA - Administrative Simplification Compliance Act
Medicare Arkansas Medicare Services
Urinalysis, AC-02-015
HER2 TESTING, AC-99-515
Missouri Medicare Services
HER2 Testing, AC-99-515
Urinalysis, AC-02-015
New York (Empire Medicare)
Prostate Specific Antigen, LB012E00
Coordinated LMRP for Empire New Jersey and New York
Electronic Submission of Medicare Claims to be Required
California NHIC - Local Modifiers Eliminated
Jun 27, 2003
CMS
CCI - Changes to Correct Coding Edits, Version 9.2
Diagnosis Codes for Screening Pap Smear
NDC - New Lab NCD Coding Release On CMS Website
Prothrombin Time and Fecal Occult Blood
Lipid Testing - Clarification of ICD-9-CM Codes for Hypertension
Prothrombin Time and Partial Thromboplastin Time - Revision of ICD-9-CM Codes for Pre-operative Examinations
California Medicare
NHIC - Retired LMRPs
May 23, 2003
CMS
- NCA Blood Glucose Testing (Revision of ICD-9-CM Codes for Osteomyelitis) (#CAG-00183N)
ESRD Policy
Adds Code for Screening Pap Smears
Medicare Additional Document Request (ADR) Policy
New Time Frame for Appealing Medicare Claim Determinations
NHIC - Electronic Eligibility 270/271 Transaction to be Supported in Real-Time
High Sensitivity C-Reactive Protein
CA Updates - Urinary FISH Test for Recurrent Bladder Cancer
Medicare Billing Update - Modifier Expansion
LMRP Updates
Apr 04, 2003
CMS
NCD Updates - Susceptibility Study Denials
Implementation Dates for the HIPAA 4010
Medicare Coverage Policy home page has changed
Medicare Coverage Advisory Committee
California and New England - NHIC
Implement modification to the ANSI X12N version 4010
Changes to NCD software - changes to the edit software for clinical diagnostic laboratory NCDs implemented
New LMRPs Impact Labs
Mar 03, 2003
Compliance/OIG
OIG Advisory Opinions posted on web site
HIPAA - CMS released documents regarding the Electronic Transactions and Code Sets part of HIPAA
Managed Care - Former Aetna Executives Form Patient Advocacy Company
Medicare - New UPIN Site
CMS to expand Serum Iron Coverage Policy
CMS Issues Quality Improvement Rule
Consolidated Billing (CB)- New Modifier for Skilled Nursing
CMS launched the Medicare Coverage Database
State Carrier Update
Connecticut - Scheduled to convert to the MCS
Feb 03, 2003
HIPAA - New HIPAA Privacy rule effective
LMRP Revision for California NHIC carrier
Revenue Opportunity For Labs
Sample Medicare Carrier Reimbursement Rates for Enterix InSure Test
Pathology TC Billing
Claim Denials - CMS Transmittal AB-02-184
Ordering Diagnostic Tests
Remittance Advice Remark and Reason Code Update - CMS Transmittal AB-03-012
Railroad Medicare - MCS is coming
Dec 31, 2002
Coding - CCE Version 9.0 Updates
New 2003 HCPCS Codes
ICD-9-CM Coding for Diagnostic Tests
Compliance/OIG - Safe Harbors and Special Fraud Alerts
HIPAA - Eligibility Transaction to be Supported in Real-Time
ANSI X12N 270/271 version 4010 is the only version accepted for the eligibility inquiry and response transaction
Implementing the Federal Health Privacy Rule in California
Hospital, Outpatient PPS
Medicare - Final Medicare 2003 Physician Fee Schedule
Standardized ABN Use Mandatory
Dialysis Claims
2003 Part B Travel Allowance Rates
2002 Non-Covered Charges Related to ABNs Submitted on Outpatient Claims -CMS Joint Memorandum
2003 Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment Method
Electronic Patient Records Via Non-Internet Means
State Carrier Update
Connecticut Medicare is scheduled to transition to the MCS
Medicaid
Blue Cross Announces Plans To Leave Orange County's Cal Optima Program
Oct 07, 2002
Coding - CMS inserts 54,955 changes into National CCI Version 8.3
Compliance/OIG - Safe Harbor Under the Anti-Kickback Statute
Work Plan for Fiscal Year 2003 Posted
OIG Issues Special Advisory Bulletin Addressing Illegal Patient Inducements
HIPAA - CMS Reports Only 3% of HIPAA Extensions filed
Managed Care - Lifeguard HMO will cease operations
Medicare - Implementation of New ABNs
Frequency Limits - ABN-G requires a provider to indicate the limits on the ABN. ABN-L does not have this requirement.
Standing Orders for Skilled Nursing Facilities
Revision to the Medicare Carriers Manual (MCM) Part 4 - Professional Relations
CMS Web Site Retired - a new Web site was created
State Carrier Updates
Pennsylvania - Subscribe To New Mailing Lists
Local Medical Review Policy notification list
Letter to All Providers Re: ABNs
CIGNA - Tennessee, North Carolina, Idaho - LMRPs
California - EDS has been awarded the contract for Medicaid services over the next eight years.
California Medicaid is now checking some diagnosis codes for the highest level of specificity.
Safety - Ways and Means Committee Approves Patient Safety Bill
Sep 02, 2002
Coding - Big Changes to ICD-9-CM 2003
Compliance/OIG -Recent and Expired Corporate Integrity Agreements
HIPAA - HHS Issues Final Modifications to Privacy Regulation
Hospital Outpatient Prospective Pay - Correction Notice
Managed Care - Hawaii Medical Association Files Suit over Insurer's Alleged Use of Software to Reduce, Deny Physician
Medicare - CMS Shortens appeals Timeframe for Denied Claims
First Coast Service - Connecticut and Florida - Provider Notification of Local Medical Review Policy (LMRP)
Pennsylvania - HGSA - Additional Modifier Print Information
Diagnosis Codes Must be Valid for Date of Service Reported
Aug 12, 2002
Compliance/OIG - Purchase of Dialysis Equipment and Supplies
CMS
Hospital Outpatient Prospective Pay - CMS ISSUES PROPOSED OUTPATIENT FEE SCHEDULE
CLARIFICATIONS ISSUED ON MEDICARE ENROLLMENT PROCESS
Medicare
Updated ICD-9-CM codes
State Carrier Updates
Idaho - CIGNA - modified CSC Task Order for the Western Integrity Center
Pennsylvania - HGSA - Information on Next LMRP Open Session Now Available
Jul 21, 2002
Compliance/OIG - Re-negotiating Corporate Integrity Agreements
CCI Version 8.0
HIPAA - Final Rule for Employer Identifier
Medicare - Payment for Purchased Services: CMS Clarification
Delay in enforcement of NDCs for Clinical Diagnostic Laboratory Services
Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2003
2003 Pathology Fees Proposed Rule
ABN Notice
State Carrier Updates
Arkansas Medicare - Proposes 2003 Physician Pay Changes Standards For Physician Data Input Eased
July Policy Notice Newsletter
ANSI Reason Code Guidebook Available Online
Reason codes explain why a claim may not have been paid in full
California - NHIC - reduced funds for Provider Education and Training
45-day notice period for final LMRPs
HCPCS codes and CCI Modifiers are available
Southern California article on Blood Glucose Testing LMRP Correction
Invalid HIC Numbers
Standard Paper Remittance Advice Notice
Connecticut - First Coast Service Options
No Newsletters Will Be Printed Between July and September 2002
2002 Medicare Part B Materials Order Form
2002 Local Connecticut Education & Training
Florida - First Coast Service Options
MC - Post Transition Issues Updated
Missouri - July Policy Notice Newsletter
New England - NHIC - the General Office Billing Guide Updated
Pennsylvania - HGSA - September Medicare Report Only Available via Internet
Medicare Part B Reference Manual has been updated with Revision 53
Jun 24, 2002
Compliance/OIG - "Solicitation of Information and Recommendations for Revising the Compliance Program Guidance for the Hospital Industry" published
Frequently Asked Questions posted on web site
Corporate Integrity Agreements posted on web site
HIPAA - Model Compliance Extension Plan and Instructions Available
Employer Identifier - Standard Unique Employer Identifier final rule published
Hospital Outpatient Prospective Pay posted document on web site
Medicare - CMS issue a quarterly update of all changes to Medicare instructions affecting affect providers
Provider Address Changes - CMS announced a new policy for handling returned mail
State Carrier Updates
Florida - First Coast Service Options - Posts Request for Review Form on web site
Conversion to Medicare's MCS
FCSO Continues to Perform Mass Adjustments
Education & Training - 2002 Events
Pennsylvania - HGSA - Posted June 2002 Medicare Report
Common Working File Duplicate Edits
Safety - Nursing Homes Will Be First Industry to Face Ergonomic Guidelines
Jun 04, 2002
Managed Care - California Legislature - amends AB 142
OIG
Advisory Opinion 01-6
OSHA
To Limit Enforcement Of Needle stick Rule While Providing Training
Mar 25, 2002
OIG
February 2002 Exclusions and Reinstatements Posted
CMS
Clarifies Issues Surrounding Transaction Compliance Extension
HHS Proposes Easing Consent Requirement in Medical Privacy Rule
Implementation of Diagnosis Codes at the claim level
MediCaid - California - How Will the Budget Deficit Impact Medi-Cal?
Medicare - Revised ABN Instructions and When to use GA, GY and GZ Modifiers
CMS Outlines Policies Related to Processing Clinical Lab Claims
Hospital Outpatient Prospective Pay - Correction of Certain Calendar Year 2002 Payment Rates
State Carrier Updates - California NHIC
Northern California Specialty pages Updated: ESRD, Lab
Southern California Specialty pages Updated: Laboratory/Pathology
Northern California is retiring the local medical review policy for TORCH panel testing
Northern California is retiring the local medical review policy for the Arthritis Panel
DC/Metro/Delaware- TrailBlazer Health Enterprises Announces new web site
Florida - First Coast Service Options
Idaho/North Carolina/Tennessee - Cigna
New England - NHIC -Seven LMRPs) retired
Pennsylvania - HGSA - Update to Block 11 Information
South Carolina - Palmetto GBA - Palmetto GBA posted new and improved registration process on web site
Mar 18, 2002
Medicaid - California - How Will the Budget Deficit Impact Medi-Cal?
State Carrier Updates - California NHIC
Northern California is retiring LMRP for the Arthritis Panel
Feb 18, 2002
Laboratory Billing/Coding Labor Shortage
Compliance - Legal Corner has been updated
OIG - introduced a new look for their web site
HIPAA - outline of the basic requirements
Medicare - coding and payment rates for new clinical laboratory tests
Revised Timelines for HIPAA Requirements
Uniform Lab Test Coverage
Voluntary ABN-X - Feb 2002 Update
State Carrier Updates
California NHIC - Southern California improved downloadable publications index
Northern California updated with the most recent articles
Northern California expands LMRP for Hepatic Functional Panel
Florida - First Coast Service Options
Feb 04, 2002
Compliance - OIG posted updated "Downloadable" Exclusions Database (LEIE) file
Audit Reports posted on website
Inspection Report Summary
HIPAA - Administrative Simplification Compliance Act signed into law
Hospital Prospective Pay - CMS has put on hold update to the OPPS
Intermediary PM lists new HCPCS
CMS
PM Delay of the 2002 Update to the Outpatient Prospective Payment System (OPPS)
CMS
posted a hospital outpatient PPS document on website
Medicare - CMS holds hearing on coding and payment rates for new clinical laboratory tests
State Carrier Updates
California NHIC - CCI edits version 8.1 are implemented
NHIC accepts feedback on LMRPs
New 213 area code number for Southern California EDI Submitters
Cigna - The Winter 2002 EDI Edge is now available
CIGNA Medicare announces the launch of section dedicated to HIPAA implementation
Connecticut First Coast Service an issue identified with data files received after 12:00 p.m. on January 18, 2002
New England NHIC - Three Draft LMRPs available for comments
Pennsylvania HGSA - The Medicare Part B Reference Manual has been updated with Revision 51
Medical policy L-11 - Consultative Pathology Services retired
Clinical Lab Billing Guide updated
ESRD - CMS PM Medicare Coverage of Noninvasive Vascular Studies for ESRD Patients
Dec 31, 2001
Compliance/OIG -
CIAs posted
Federal Register Notice - New Safe Harbors and Special Fraud Alerts
HIPAA - Transactions Delay Bill Passes (Bill, H.R. 3323)
Medicare -
HR 3388 would increase the reimbursement for Specimen Collection
HR 3388 was introduced
New Medicare Database Expected to Streamline Eligibility
Outpatient PPS
Negotiated Rulemaking
Connecticut Medicare -
FCSO Medicare Provider Website available
Medicare Part B of CT HIPAA Electronic Transmission standards posted on web site
2002 Chiropractor Fee Schedule (Disclosure Report) posted on web site
Florida Medicare
First Coast Service Options (FCSO) Inc. will transition to MCS
HIPAA Electronic Transmission standards, testing information and submission information posted on web site
New England Medicare
December 2001 edition of the Medicare B Resource is available
EDI Vendor Directory is updated
December 2001 EDI Newsletter posted to web site
Pennsylvania Medicare
Special Message posted to web site
December 2001 Medicare Report posted
Dec 10, 2001
Compliance - OIG
Stark II rule
OIG's 2002 Work Plan
Laboratories - CLIA Certifications
Lab Audit Follow-up
Uncollected Beneficiary Deductibles and Coinsurance
Diagnosis-Related Group Payment Window-Part B Providers
Outpatient Prospective Payment System
Modifications to Office of Inspector General (OIG) policies and practices
CIA Review
HIPAA - HOUSE PASSES HIPAA DELAY BILL
Hospital Prospective Pay - Changes to the Hospital Outpatient PPS for Calendar Year 2002
Federal Register Final Rule (CMS-1159-F2)
Medicare
NEGOTIATED RULEMAKING FINAL RULE
Physician signatures will not be required on lab requisitions
Uniform laboratory policies
HOUSE PASSES "THE MEDICARE REGULATORY AND CONTRACTING REFORM ACT OF 2001"
CMS TO DELAY A PORTION OF THE STARK II REGULATION
Connecticut Medicare - The website search function is back online
Florida Medicare - The website search function is back online
Pennsylvania Medicare - HGS Administrators changed its Beneficiary toll free customer service telephone number
Nov 12, 2001
Compliance - CIAs available on OIG website
Federal False Claims Act
Record Retention Requirements
Coding - New CPT codes for 2002 Clinical Laboratory Fee Schedule
Medicaid - California Medi-cal RTD's Discontinued for Provider Number Issues
EDS Plans HIPAA compliance by June 2002
Medicare - ABN-X/ Billing for Non-covered services
CMS issued two new modifiers for billing Part B non-covered services
CMS Revises MSP Data Collection for Hospitals
ICD-9-CM Coding for Diagnostic Tests
Notice of Interest Rate for Medicare Overpayments and Underpayments
Correct Coding Initiative (CCI) Edits Version 8.0 Available
Appeals Process - CMS has revised Section 12000 of the Medicare Carriers Manual
Information for Health Plans and Providers
Lab Carrier Consolidation - CMS is asking Congress to rescind the Regional Laboratory Carrier provision
Phlebotomy - The National Committee for Clinical Laboratory Standards offers a series of videos teaching various aspects of blood specimen collection.
Oct 22, 2001
California - Legislative Action
Governor Gray Davis passes: AB 1490, SB 131
Managed Care - Bankruptcy Court Approves Sale of Maxicare Medi-Cal Plan to Molina Healthcare
Medicare - NHIC - CAC Committee News
Answers to CCLA workshop questions
Coding CPT4 - 2001
CPT5 - 2002
Drug Coding
Medicaid - California
HIV Phenotyping
A web-based application allows provider Inquires
Medicare - Program Memorandum clarifies the current coding guidelines for reporting diagnostic tests
Oct 08, 2001
California - Davis Signs SB 111s Into Law
Maxicare, Tower Health Likely to be Dissolved by End of Year
DMHC Fines Health Net $100,000 for Late Payments to Providers
HIPAA - House Committee Members Urge Implementation of HIPAA Regulations
California Medi-cal - Medi-cal will stop using RTD's
Medicare - NHIC
- Clinical Trials- California Medicare
HHS Launches Medicare Accounting Systems Integration Project
Northern California LMRPs Affected by 2002 ICD-9-CM Updates.
OIG - Advisory Opinion 01-16- Employment of an excluded physician
Growth of foreign clinical trials for New Drug Applications
Work Plan for Fiscal Year 2002 Posted
Advisory Opinion No. 01-15 - Managed Care Subsidization
Answers to CCLA workshop questions
Dialysis BUN/Creatinine Non-payment
New ABN form. Who should obtain it and what are the beneficiary notice guidelines.
How to Avoid and/or expedite a Medicare appeal
Sep 24, 2001
Medicare - Enrollment and Certification Processes in the Clinical Laboratory Improvement Amendments Program
New Provider Enrollment Forms Not Yet Available
ICD-9-CM Diagnostic Coding Updates
Sep 17, 2001
Compliance - Urocor Corporate Integrity Agreement
Corporate Integrity Agreements
Media Alert and Survey Results of CIA Survey
Building a Partnership for Effective Compliance
Medicaid - California link to the Medical Board of California
Medicare - ABN Frequently Asked Questions
California - NHIC will be adopting a new LMRP
Medicare + Choice - changing benefit packages
Pre-Op Exams - Laboratory tests
Third Party Insurance News
AETNA Pulls HMOS From California, Louisiana Markets
Blue Cross Blue Shield - no longer offer the federal HMO
Department of Managed Care Takes Over Tower Health
CHAMPUS
Aug 27, 2001
Claims Processing Facts
FDA - ASR Testing FAQs
Medicare - 2002 Hospital Outpatient Rule Proposed
ABNs - CMS most likely will not issue permanent instructions for the use of the new ABN until April 2002
California - NHIC - Clinical Lab Gap Fill amounts were released
Random prepayment audits
Pennsylvania Medicare - HGSA publishes clarification
OIG - Final Notice of Modification of OIG Advisory Opinion No. 98-5
Closed Corporate Integrity Agreements
Aug 13, 2001
MEDICARE
CMS RELEASES 2002 PROPOSED PHYSICIAN FEE SCHEDULE
New Medicare benefits:
HIPAA - CMS Program Memorandum AB-01-96
Guidance for Physicians on Documentation in Patient Charts
Scully Promises to Improve Medicare+Choice
OIG
CLIA Regulation of Unestablished Laboratory Tests (OEI-05-00-00250)
Frequently Asked Questions -Corporate Integrity Agreements
Medicaid
California Medi-Cal - 2001-02 budget signed into law
Osteopathic Referring Physician Providers ( In-State & Out -of -State)
Osteopaths need to get a Medical provider number
HIPAA - Covered entities must provide reasonable safeguards to avoid prohibited disclosures
OSHA - Blood borne Exposure Advice Now in One Guideline
Jul 30, 2001
OIG - Corporate Integrity Agreement with Sun Healthcare Group, Inc.
Medicare - Hospital OPS program memorandum released
Managed Care - Provides link for Provider Dispute Resolution.
LOINC - Committee Meeting
Medi-cal - New CMC Claims Submission on the Internet
Jul 16, 2001
Medicare - The President's Framework to Strengthen Medicare
New ABN for Laboratories
Category III CPT codes for 2002
OIG - posted the following Corporate Integrity Agreements
Outpatient Prospective Payment System - PM: Use of Modifier -25 and Modifier -27
Application Deadlines for Transitional Pass-Through Payment for Drugs and Biologicals and New Technology Services Eligible for Payment Under the Hospital Outpatient Prospective Payment System Posted
HIPAA - HHS Issues First Guidance on Medical Privacy Regulations
California News - EDS Signs Contract to Administer Online Medi-Cal, Healthy Families Enrollment
Orange, Riverside Counties Exempt From Mexican Doctors Bill
Stanford's HMO Pullout May Overwhelm Area Providers
Jun 18, 2001
CMS
Encourages Electronic Funds Transfers
Personnel Changes
Preoperative Testing Implemented
PAP Smears
Three Centers Of Business
National Heritage EDI Update
Appeals Process
Eligibility
OIG - Review of Potential Improper Payments
Medicaid of California - EDS is cross-linking their provider files with those from the Consumer Board
Diagnosis Requirement
Claims submission via the Internet
May 21, 2001
Bush Fiscal Year 2002 Budget Proposal Includes Higher User Fees Than Clinton
Revised Outpatient PPS Payment Rates Posted
CCN - First PPO to Eliminate Medical Necessity Requirements by Introducing New Alternative to Traditional UR
CMS
- National Medicaid HIPAA Conference
OIG
Reports
Self-Disclosure Information
May 07, 2001
NHIC - After Hours Pickup Fee
CCN Implements HIPAA-Compliant Edi Transaction
OIG - Testimony before the Finance Committee on Improper Payments
HIPAA - X12N Insurance Subcommittee Announcement
Apr 23, 2001
CMS
Supervision Rules For Diagnostic Tests
Revised ABN
V76.47
HIPAA - Medical Privacy Rules
Safety Needles
California - Engaging in Business with Suspended Providers
Apr 09, 2001
CCN PARTNERS WITH NATIONAL CARE NETWORK
Medicare Privacy Consent - GAO releases report "Medicare Privacy Regulation"
Fraud and Abuse - 2002
CMS
FACTS - Acting Inspector General provided testimony before the House Energy and Commerce Subcommittees
CMS
is the largest single purchaser of health care in the world
Apr 02, 2001
CMS
PAP Smear Fees
Hospital Outpatient Prospective Payment System
California Medicaid - Reference Lab Field