Posted on December 9, 2009
CR 6563 announces recent instructions for the use of modifiers in association with Advance Beneficiary Notices (ABN). Specifically, effective April 1, 2010, two HCPCS level 2 modifiers have been updated to distinguish between voluntary, and required, uses of liability notices. Those modifiers are:
Modifier – GA has been redefined to mean "Waiver of Liability Statement Issued as Required by Payer...
Posted on December 2, 2009
WPS Medicare – Carrier/FI for Iowa, Illinois, Kansas, Minnesota, Michigan, Missouri, Nebraska and Wisconsin.
Recently, WPS Medicare received the following question and statement, "Do initials satisfy Medicare's documentation requirements? Our physician feels that providing a full "signature" to each medical record is not efficient and is time consuming."
A valid signature (electronic or...
Posted on December 2, 2009
Medicare regulations establish a time limit for submitting claims to the contractor within the established timeliness parameters. In general, such claims must be filed on, or before, December 31 of the calendar year following the year in which the services were furnished. Services furnished in the last quarter of the year are considered furnished in the following year; i.e., the time limit is the...
Posted on December 2, 2009
At the request of Members of Congress, the Federal Trade Commission is delaying enforcement of the "Red Flags" Rule until June 1, 2010, for financial institutions and creditors subject to enforcement by the FTC.
The Rule was promulgated under the Fair and Accurate Credit Transactions Act, in which Congress directed the Commission and other agencies to develop regulations requiring "creditors"...
Posted on December 2, 2009
RAC for Region D: HealthDataInsights, Inc. of Las Vegas, Nevada
The RAC (Recovery Audit Contractor) will issue an overpayment demand when it finds a provider was paid for a global diagnostic procedure and also received payment for the procedure's technical or professional components. An overpayment exists when providers are reimbursed for global procedures and then receive additional...
Posted on December 2, 2009
Noridian Administrative Services, LLC- Carrier/FI for Arizona, Alaska, Idaho, Oregon, Montana, North Dakota, South Dakota, Utah, Washington, Wyoming and Minnesota.
Noridian Administrative Services, LLC (NAS) has noticed an increase of incorrect coding for Complete Blood Count (CBC) and Urinalysis (UA) laboratory services. Recent Comprehensive Error Rate Testing (CERT) analysis indicates...
Posted on December 2, 2009
TrailBlazer Health Enterprises® - Carrier/FI for Colorado, New Mexico, Oklahoma, Texas and Virginia.
Due to the recent increase in the number of errors identified during the Comprehensive Error Rate Testing (CERT) contractor audit for the lack of physician orders for diagnostic tests, TrailBlazer recommends that providers sign all orders for testing and/or progress notes showing the intent for...
Posted on December 2, 2009
Cahaba Government Benefit Administrators®, LLC -MAC for Jurisdiction 10, which includes Alabama, Georgia and Tennessee
Modifier 59 is an NCCI-associated modifier that is often used incorrectly. This modifier should be used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. This may represent a different session or patient...
Posted on December 2, 2009
New York State Medicaid
Effective December 1, 2009, all orders for laboratory or radiology procedures must indicate the diagnosis by use of the appropriate ICD-9-CM code. Use of general ICD-9-CM codes such as those listed below or other non-specific codes does not satisfy this requirement. The following ICD-9 diagnosis codes are invalid as primary diagnosis codes for purposes of Medicaid...
Posted on December 2, 2009
As part of the Obama Administration's goal of reducing waste, fraud and abuse in Medicare, the Department of Health and Human Services and CMS significantly revised and improved its calculations of Medicare fee-for-service (FFS) error rates in 2009, reflecting a more complete accounting of Medicare's improper payments than in past years. These improvements will provide CMS with more complete...
Posted on December 2, 2009
First Coast Options- MAC for Jurisdiction 9, which includes Puerto Rico, the U.S. Virgin Islands and Florida
Medicare pays for clinical laboratory services that are medically reasonable and necessary, ordered by a physician, and used by the physician in the treatment of the patient. When a physician documents an order for a complete blood count (CBC) in a patient’s medical record, Medicare will...
Posted on December 2, 2009
Noridian Administrative Services, LLC- Carrier/FI for Arizona, Alaska, Idaho, Oregon, Montana, North Dakota, South Dakota, Utah, Washington, Wyoming and Minnesota.
This article corrects a previous article published in Medicare B News Issue 256 on August 26, 2009. CPT 80050 is a non-covered panel and should not have been included in the “Organ or Disease Oriented Panels” chart. Any automated or...
Posted on December 2, 2009
Florida Medicaid
The Florida Agency for Health Care Administration (Agency) announced today that Florida is the first state to launch a Medicaid claims-based electronic health record portal for providers. The Florida Medicaid Health Information Network powered by Availity is available through a common portal where similar records from other payers may also be accessed. This will allow health care...
Posted on December 2, 2009
CMS will delay, until April 5, 2010, the implementation of Phase 2 of Change Request:
(CR) 6417 (Expansion of the Current Scope of Editing for Ordering/Referring Providers for Claims Processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs)) and
CR 6421 (Expansion of the Current Scope of Editing for Ordering/Referring Providers for Durable Medical Equipment,...
Posted on December 2, 2009
This article announces the changes that will be included in the January 2010 release of the edit module for clinical diagnostic laboratory National Coverage Determinations (NCDs).
Posted on December 2, 2009
For Serum Iron Studies:
Delete ICD-9-CM codes 453.50-453.52 from the list of ICD-9-CM codes that are covered by Medicare for the Serum Iron Studies (190.18) NCD.
For Gamma Glutamyl Transferase:
Add ICD-9-CM codes 453.50-453.52 to the list of ICD-9-CM codes that are covered by Medicare for the Gamma Glutamyl Transferase (190.32) NCD.
NOTE: Effective dates for the following codes were...
Posted on December 2, 2009
CR 6683, advises that, effective with claims processed on or after April 5, 2010, Medicare will validate claims for AMCC ESRD-related tests provided to a beneficiary who is ESRD eligible to ensure compliance with billing instructions regarding the use of the ESRD 50/50 rule modifiers CD, CE, and CF.
The payment of certain ESRD laboratory services performed by an independent laboratory is...
Posted on December 2, 2009
CR 6563 announces recent instructions for the use of modifiers in association with Advance Beneficiary Notices (ABN). Specifically, effective April 1, 2010, two HCPCS level 2 modifiers have been updated to distinguish between voluntary, and required, uses of liability notices. Those modifiers are:
Modifier – GA has been redefined to mean "Waiver of Liability Statement Issued as Required by...
Posted on November 13, 2009
The Dept.of Defense is removing SSNs from their ID cards in three phases.
Posted on November 4, 2009
Effective for dates of service on or after October 1, 2009, CPT codes 82040 and 82043 can be billed with modifier QW.