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Industry News

To help you stay up-to-date with the constant changes in medical billing, XIFIN compiles and publishes these articles, which cover the most important topics in the medical billing industry. Please check for new articles each month, or subscribe to our newsletter updates.

  • Los Angeles judge blocks state budget cut to Medi-Cal providers

    Wednesday, February 01, 2012

    A Los Angeles federal judge has tentatively blocked Medi-Cal reimbursement cuts to doctors and other providers who treat low-income patients. U.S. District Court Judge Christina A. Snyder ruled today that the state cannot reduce payments by 10 percent to Medi-Cal doctors, dentists, ambulance services and other providers. The tentative decision comes after Snyder previously blocked cuts to hospital-based nursing units and some pharmacists.

  • Clarification Concerning HIPAA 5010 and NCPDP D.0 Cut-Over and Impacts on Crossover Claims

    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.

  • Medicare FFS version 5010 requirement changes for non-specific procedure codes

    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.

  • MSP Deductible Issues regarding CR 7026

    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.

  • Medicare EHR Incentive Program and Information on the Payment Threshold for Eligible Professionals - Upcoming Dates

    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.

  • CMS Special Open Door Forum on End Stage Renal Disease Quality Incentive Program for Payment Years 2013/2014 Final Rule and Benchmark Data Overview

    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.

  • Medicare Remit Easy Print (MREP) Version 3.2.2 is Now Available

    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.

  • Updates from the Medicare Learning Network

    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.

  • Billing/Coding Alert: Semi-Quantitative Drug Testing

    Tuesday, January 31, 2012

    Potential primary billers at risk: Pain Management

  • January 2012 MolDx Program Update

    Tuesday, January 31, 2012

    As a result of the comments from the lab industry on the MolDx program, Palmetto has made the following program updates: Published MolDx Exempt Tests: This chart details tests that require a Z-Code and a Technology Assessment (TA). As exceptions are identified, we will continue to update this chart. Z-Code Application Changes: To simplify the application process, ONLY the minimum information necessary to assign a Z-Code will be required. All other informational columns have been removed or listed as optional entry fields.


  • Z-Code Registration: Revised

    Tuesday, January 31, 2012

    Palmetto GBA will roll out the MolDx Program in phases to facilitate the process for our laboratory service providers. Please plan to submit only the basic components listed on the spreadsheet for Z-Code application. • Within one business week, we will email an application receipt notice to you • Within 30 business days of a valid submission, we will send email notification with your Z-Code assignment • For invalid applications, we will list the specific information needed to correct your application

  • Timely Filing Guidelines

    Tuesday, January 31, 2012

    • Original claims must be filed by the provider and received by the state agency within twelve (12) months from the date of service. Any claims that originally were submitted and received within twelve (12) months from the date of service, but were denied or returned to the provider, must be resubmitted and received within twenty-four (24) months of the date of service.

  • Genetic Testing Authorizations

    Tuesday, January 31, 2012

    Codes 83890-83909 require authorization only when the genetic modifiers OA (BRCA1) or OB (BRCA2) are used. To complete your authorization request: • Use the MN–ITS Authorization Request (278) transaction • Bypass the edit ‘The submitted procedure does not require authorization’ by selecting ‘I would like to: Ignore errors and continue’

  • Ordering/Referring Professional

    Tuesday, January 31, 2012

    Effective for dates of service on or after 2/1/2012, report the NPI of the professional who ordered or referred the service on all claims requiring an ordering/referring professional. Use the MN–ITS Ordering/Prescribing Provider List to verify the ordering professional is enrolled with MHCP and to obtain their NPI, if not known.

  • ProviderOne to start updating license information effective January 23, 2012

    Tuesday, January 31, 2012

    As of January 23, 2012, ProviderOne will automatically update professional, pharmacy, and hospital license information from an interface with the Washington State Department of Health (DOH) for all Washington State providers. The license information will be retrieved directly from the DOH on a daily basis and will update license information in ProviderOne. Shortly after the license update process begins in ProviderOne, claims will begin to deny for expired licenses.

  • Timely Filing

    Tuesday, January 31, 2012

    Effective September 1, 2010, the timely filing limit for Medicaid fee for service and Children’s Medical Services claims changed to: • 90 calendar days from the date of service for all providers. Any outstanding claims for which a provider wishes the current limits to apply rather than the new 90 calendar day limit must be received by ACS prior to September 1, 2010.

  • CAP asks CMS to Delay or Revoke Palmetto’s MolDx

    Tuesday, January 31, 2012

    Representatives from the College of American Pathologists met with CMS to express concerns regarding the Molecular Diagnostics (MolDx) reporting program announced by Palmetto GBA in November 2011, and asked CMS to delay or revoke the program. Palmetto's adoption of the Z-codes amounts to the creation of a local coding system, which violates the Health Information Portability Act (HIPAA), CAP leaders told CMS during the meeting.

  • Extension of Moratorium That Allows Independent Laboratories to Bill for the Technical Component of Physician Pathology Services Furnished to Hospital Patients

    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.

  • Stay on Track and Complete Your Version 5010 Upgrade

    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.

  • HHS Adopts HIPAA Standard for Electronic Funds Transfers/Remittance Advice

    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.



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