Billing News Tags: Clear Claim Connection™ To Reflect Correct Coding Rules For Cla

Physicians will get a 10-month reprieve from a 27.4 percent cut in Medicare payments scheduled for March 1 under a tentative agreement reached Tuesday by a House-Senate committee. A payment freeze will be in effect through the end of the year.
Effective for dates of service on or after November 8, 2011, CMS will cover screening for Sexually Transmitted Infections (STIs) - specifically chlamydia, gonorrhea, syphilis, and hepatitis B - with the appropriate FDA approved/cleared laboratory tests when ordered by the primary care provider.
Change Request 7631 revises and clarifies national policy for POS code assignment. Instructions are provided regarding the assignment of POS for all services paid under the MPFS and for certain services provided by independent laboratories.
CR7694 announces the latest 11 tests approved by the FDA as waived tests under CLIA effective April 2, 2012. The CPT codes for the following new tests must have the modifier QW, defined as CLIA waived test, to be recognized as a waived test.
Change Request (CR) 7688 implements a standard "immediate recoupment" process that gives providers the option to avoid interest from accruing on claims overpayments when the debt is recouped in full prior to or by the 30th day from the initial demand letter date.
A new list of "other" HCPCS Level II codes to be added or removed for the second quarter of 2012 is now posted on the CMS website. CMS is adding five temporary (non-Medicare) "S" codes and deleting 20 "S" codes that describe mainly genetic testing.
Prior to the implementation of HIGLAS (the Healthcare Integrated General Ledger Accounting System), Medicare’s Multi-Carrier System (MCS) created just one check per sender, National Provider Identifier (NPI), or legacy ID.
This article describes initiatives that both CMS and the COBC are undertaking to maintain the most up-to-date and accurate beneficiary MSP information on Medicare’s Common Working File (CWF).
Medicare Remit Easy Print (MREP) software is available for free to Medicare providers and suppliers and can be used to access and print remittance advice information, including special reports, from the HIPAA 835.
Tuesday, January 3rd, was the one-year anniversary of the start of registration for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. Over the past year, there has been a tremendous amount of interest in the incentive programs as providers across the country have implemented EHRs.
Enhancements and changes have recently been made by CMS to the EHR Information Center Interactive Voice Response (IVR) system. Among these caller-friendly revisions is a new feature to assist with Hot Topics, including registration and attestation, as well as updated Password Reset menus.
CMS wants to help keep you updated with information on the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, and has recently updated previously-posted FAQs and added new FAQs on several incentive program topics, including reporting periods and incentive payments.
The CMS EHR Incentive Program listserv provides timely information on program requirements and changes in the EHR Incentive Programs.
Palmetto GBA has changed the effective date for claim submissions under its new Molecular Diagnostic Services Program (MolDx) from March 1 to May 1 and will give laboratories a choice between applying for the McKesson Z-Code or an alternate test identifier from Palmetto.
VeriStratÆ is a new blood test that will help determine if a patient is likely to benefit from a specific lung cancer therapy.
The following contains Revised Coverage and Reimbursement for Drug Screening Tests: (1) Effective for service dates on or after October 1, 2011, the following changes in coverage, reimbursement and billing procedures shall apply to laboratory claims for drug screening tests: • CPT G0434/G0434QW are new procedure codes for billing the use of a m
The 2012 annual ICD-9-CM diagnosis code update is currently in progress. Providers will be notified by web announcement when the codes are entered in the system and claims will no longer deny for the codes not being available. Please use the following billing instructions:
New federal rules and regulations require that all enrolled providers revalidate their enrollment at least every five years. Revalidation will include attestation of credentials as well as the agreement to abide by the rules and regulations of the Medicaid program. Certain provider types will be required to pay a fee for revalidation.
The New York State Medicaid Program is included in the current cycle of the Payment Error Rate Measurement (PERM) Program, implemented by CMS to measure improper payments in areas of significant public expenditures.
The National Correct Coding Initiative (NCCI) promotes national correct coding methodologies and controls improper coding leading to inappropriate payments in Medicare Part B claims. The purpose of the NCCI edits is to prevent improper payments when incorrect code combinations are reported.
TMHP has identified an issue that impacts claims that were submitted by hospitals for outpatient clients for clinical laboratory services procedure code 81007. Affected claims that were processed from April 1, 2010, through December 13, 2011, were reimbursed using an incorrect methodology.
TMHP has identified an issue that impacts claims for the following laboratory services: 84431, 85013, 85018, 86001, 86003, 86005, 87205, 87797, 87900, 87901, 87903, 87906, 88237 and 88239
TMHP has identified an issue that impacts outpatient claims that were submitted with procedure code 80050 and dates of service from April 1, 2011, through August 31, 2011. These claims may have been paid at an incorrect rate by Texas Medicaid.
The following Texas Medicaid benefit changes have been made to support the 2012 HCPCS and CPT updates and are effective for dates of service on or after January 1, 2012. Added
During the first quarter of 2012, the Clear Claim Connection reference tool will reflect the ClaimsXtenô clinical rule processing. ClaimsXten is a product of McKesson, an international health care services and information technology company.
You’ll find the latest information about procedure codes and Blue Cross Blue Shield of Michigan billing guidelines in the following chart. The codes that have a change to a billing guideline or added a new payable group will appear under Updates to Payable Procedures.
Beginning Jan. 1, 2012, the AMA has established additional Molecular Pathology Procedure test codes. Each of these new Molecular Pathology Procedure test codes represents a test that is currently being used and that may be billed with existing CPT codes.
TriWest Healthcare Alliance (TriWest) has revised the list of codes requiring prior authorization on the Prior Authorization List (PAL). The effective date is January 1, 2012.
The purpose of this policy is to ensure that UnitedHealthcare reimburses physicians and other health care professionals for the units billed without reimbursing for obvious billing submission and data entry errors.
A federal court judge has cleared the way for releasing payments in the 2009 settlement that ended the historic court challenge led by the AMA against UnitedHealth Group. Nearly $200 million in awards will be paid to settle claims from physicians for 15 years of artificially low payments from UnitedHealth for out-of-network health services.

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