Industry News

CMS implemented date of service (DOS) medical unlikely edits (MUEs) for some Healthcare Common Procedure Coding System (HCPCS) and CPT codes effective April 1, 2013. CMS is converting some claim line MUEs to DOS MUEs.

This National Provider Call will cover how to obtain an Individuals Authorized Access to the CMS Computer Services (IACS) account in order for (1) physician group practices to select their CY 2013 Physician Quality Reporting System (PQRS) Group Reporting Mechanism, and if applicable, elect quality tiering to calculate their CY 2015 Value-based P

The CMS website offers resources for providers, payers, and vendors to help prepare for the transition to ICD-10. Resources provide tips and advice on how to plan and execute your transition to ICD-10, including timelines, checklists, and fact sheets.

Noridian is the new Medicare Administrative Contractor (MAC) for Jurisdiction E (JE) – formerly Jurisdiction 1; California, Hawaii, Nevada (transition date 9/16/2013). As they begin the process of implementing the JE workload, they want to inform you of important changes that may impact you.

CMS has awarded the J6 A/B MAC contract for the administration of the Part A and Part B Medicare fee-for-service claims in the states of Illinois, Minnesota, and Wisconsin to National Government Services, Inc. National Government Services Jurisdiction 6 MAC transition Web site has been launched.

Because the MoPath Tier 2 CPT code descriptions do NOT identify the specific genes tested, laboratory providers that have not obtained a unique 5-digit ID through Palmetto GBA or McKesson Dex must provide additional information until an ID is obtained. As per the MolDx Program, claims submitted in J1 without a unique ID will be denied.

UnitedHealth is facing scores of complaints, including long backlogs for members to reach customer service and delays in providers obtaining referrals, since taking over a huge $20 billion contra

You’ll find the latest information about procedure codes and Blue Cross Blue Shield of Michigan billing guidelines in the following chart. Procedures that have changed a billing guideline or added a new payable group will appear under Updates to Payable Procedures.

A system error caused duplicate Medicare Supplement claim payments to be issued to providers who submitted corrected claims intended to replace previously processed claims.  Typically, BCBSNC just reverses and cancels out the first claim received, and reprocess the corrected claim for an additional payment or refund request.  However, when corre

Due to the increased demand of preliminary drug screens performed in the clinic setting, MO HealthNet has added coverage of procedure code G0434, “Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter”.

As the Oct. 1, 2014, implementation deadline for ICD-10 draws closer, legislation was introduced in the U.S. House of Representatives to bar the federal government from rolling out the new code set. The Cutting Costly Codes Act, introduced by Rep. Ted Poe, R-Texas, would prohibit the U.S.

Medicare believes that the evidence is adequate to conclude that MRIs improve health outcomes for Medicare beneficiaries with implanted Pacemakers (PMs) when the PMs are used according to the FDA-approved labeling for use in an MRI environment.

A service-specific probe review was completed for CPT code 83036 glycated hemoglobin (A1C) for specialty 69 (Independent Clinical Lab). Major issues identified were documentation not received and services not medically reasonable or necessary. WPS Medicare must receive the documentation requested within 45 days or we will deny the service.

The Department of the Treasury has notified the Department of Health and Human Services that the private consumer rate has been changed to 10.125 percent effective April 17, 2013, for Medicare overpayments and underpayments.