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Customer News: CMS

Tuesday, January 31, 2012

CMS has learned that concern exists in the provider community concerning whether billing of hardcopy CMS 1500 or UB04 claims or HIPAA version 4010A1 batch claims will result in Medicare being unable to cross those claims over to COBA supplemental payers that have cut-over to exclusive receipt of crossover claims in the version 5010 837 claim formats. This is not true.

Tuesday, January 31, 2012

Medicare fee-for-service (FFS) has amended the not otherwise classified (NOC) code set listing effective Monday, January 16, 2012. Various pathology and laboratory codes identified in procedure code section 8800 and a variety of other NOC codes have been removed. These codes do not meet the criteria of a non-specified procedure code and do not require a description to be supplied in the SV101-7/SV202-7 data elements.

The majority of procedure codes impacted and removed from the NOC code list are anesthesia codes, laboratory/pathology codes, and physicians quality reporting system codes.

Tuesday, January 31, 2012

On April 1, 2011, CMS implemented Change Request 7026. This instruction directed the Common Working File (CWF) to accept both Medicare Secondary Payer (MSP) and Non-MSP lines on the same claim or adjustment. As a result of this change, Medicare erroneously issued secondary payment and applied the total Medicare allowed amount towards the beneficiary’s deductible obligation on some claims. Impacted claims processed between April 2, 2011 and November 4, 2011.

Tuesday, January 31, 2012

As 2012 begins, CMS wants to remind eligible professionals (EPs) participating in the Medicare Electronic Health Record (EHR) Incentive Program of important deadlines approaching and what can still be completed in 2012 in order to receive an incentive payment for CY2011.

Tuesday, January 31, 2012

CMS will hold a Special Open Door Forum (ODF) February 2, 2012 2:00 – 3:30 PM EDT to discuss the final rule for the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) for Payment Years (PY) 2013 and 2014 and the related baseline data for PY 2014. The ODF will provide an overview of quality measures, scoring methodologies, and payment reductions.

Discussion materials for this Special ODF will be available to download at http://www.cms.gov/ESRDQualityImproveInit/ by January 31, 2012.

Tuesday, January 31, 2012

A new version of the Medicare Remit Easy Print (MREP) is now available on the CMS website to download. This upgrade will correct the printing issues experienced with MREP version 3.2.

CMS presents the Medicare Remit Easy Print (MREP) software to view and print HIPAA compliant 835 for professional providers and suppliers. This software, which is available for free to Medicare providers and suppliers, can be used to access and print remittance advice information, including special reports, from the HIPAA 835.

Tuesday, January 31, 2012

"Medicare Claim Review Programs"
• The revised "Medicare Claim Review Programs: MR, NCCI Edits, MUEs, CERT, and RAC" booklet (ICN 006973) is designed to provide education on the different CMS claim review programs and assist providers in reducing payment errors, including, in particular, coverage and coding errors. It includes frequently asked questions, resources, and an overview of the various programs, including Medical Review, Recovery Audit Contractor, and the Comprehensive Error Rate Testing Program.

Tuesday, January 17, 2012

To date we have converted 76% of our payor and trading partner connections to 5010. These represent over 90% of the claims volume; those who have yet to be converted are some Medicaids and other smaller payors who have opted to extend their 5010 transition, due in part to the CMS extension. To ensure that your claims are processing, XIFIN continues to work diligently with these payors to complete testing and convert over to 5010 as soon as they are ready. To see a current status and to access a payor-by-payor list, please visit the 5010 page on the customer portal.

Monday, January 16, 2012

On December 23, President Obama signed into law the Temporary Payroll Tax Cut Continuation Act of 2011. Included in these provisions is an extension of a moratorium that allows certain practitioners such as pathologists and independent laboratories to bill for the technical component (TC) of physician pathology services furnished to hospital patients through Wednesday, February 29. This moratorium was set to expire on Saturday, December 31. However, the TPTCCA extends that moratorium. This policy is effective for claims with dates of service Sunday, January 1 through Wednesday, February 29.

Monday, January 16, 2012

The Version 5010 deadline was on January 1, 2012; however, because of the 90-day enforcement discretion period for all HIPAA-covered entities upgrading to Version 5010, CMS will not initiate enforcement action until April 1, 2012. CMS made this decision based on industry feedback that many organizations and their trading partners were not yet ready to finalize system upgrades to be compliant.

Monday, January 16, 2012

CMS today announced an interim final rule with comment period (IFC) under which the Department of Health and Human Services (HHS) adopts standards for the Health Care Electronic Funds Transfers (EFT) and Remittance Advice transaction (RA) under HIPAA. The Patient Protection and Affordable Care Act of 2010 requires CMS to issue a series of regulations over the next five years that are designed to streamline health care administrative transactions, encourage greater use of standards by providers, and make existing standards work more efficiently.

Monday, January 16, 2012

CMS is amending Remittance Advice Remark Code (RARC) N103 to include language that further explains the newly modified RARC N103—denying claims for services to federally incarcerated beneficiaries; it reads as follows: "Social Security records indicate that this patient was a prisoner when the service was rendered.

Monday, January 16, 2012

The Office of the National Coordinator (ONC) is establishing a new system that will enable them and other interested parties to assess, improve, and publicize the effectiveness of ONC health information technology (IT) grants made to states and state-designated entities, according to a notice published Dec. 22, 2011 in the Federal Register.

Monday, January 16, 2012

Registration for the March 5, 2012 ICD-9-CM Coordination and Maintenance Committee Meeting will open on Friday, February 3, 2012. Proposals for the diagnosis codes will be discussed from approximately 1:30 pm-5:00 pm by the Centers for Disease Control (CDC).

A tentative Diagnosis agenda will also be posted in February. Please visit CDCs website for the Diagnosis agenda that is located at the following address: www.cdc.gov/nchs/icd/icd9cm_maintenance.htm

Monday, January 16, 2012

Physician Quality Reporting is a voluntary individual reporting program that provides an incentive payment to identified eligible professionals who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B beneficiaries.

To access the 2012 Physician Quality Reporting System educational products, visit the Spotlight page for the listing of educational products.

Monday, January 16, 2012

The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) has begun the process of notifying covered entities that they are among the unlucky few who have been selected for the first HIPAA privacy and security audits under the Health Information Technology for Economic and Clinical Health (HITECH) Act. The selected entities represent a cross sample of the health care industry from billion-dollar health care systems to small physician practices.

Monday, January 16, 2012

Effective January 19, 2012, the interest rate for-overpayments and underpayments will be 10.50 percent.

Thursday, December 29, 2011

In last-minute maneuverings, Congressional lawmakers Dec. 23 approved an amended version of payroll tax legislation that also would defer for two months a Medicare pay cut for physicians due to be implemented Jan. 1. House and Senate leaders reached an agreement on the measure Thursday, narrowly averting a 27.5 percent reduction in Medicare reimbursement for physicians, including pathologists.

Thursday, December 29, 2011

The MPPR on diagnostic imaging applies when multiple services are furnished by the same physician to the same patient in the same session on the same day. Currently, the MPPR on diagnostic imaging services applies only to technical component (TC) services.

Thursday, December 29, 2011

The amount that must remain in controversy for ALJ hearing requests filed on or before December 31, 2011, is $130. This amount will remain the same for calendar year 2012.

The amount that must remain in controversy for Federal District Court review requests filed on or before December 31, 2011 is $1,300. This amount will increase to $1,350 for appeals to Federal District Court filed on or after January 1, 2012.