Posted on March 4, 2010
This article is based on CR 6787 which instructs the Medicare contractors to incorporate an additional Kansas payment locality in the Clinical Laboratory Fee Schedule (CLFS) into their system to ensure correct pricing for certain laboratory claims submitted with a “90” modifier for services performed in the Kansas payment localities.
CMS discovered that there is an inconsistency in the payment...
Posted on March 4, 2010
Units of Service validation editing for procedure codes submitted from professional providers (837P or 1500 Health Insurance Claim Form) begins on the evening of December 15, 2009. Although Blue Cross and Blue Shield of Minnesota and Blue Plus are not following Medicare’s Medically Unlikely Edits (MUE), this is similar to MUEs where the verbiage of the procedure code dictates the number of units...
Posted on March 4, 2010
The Administrative Simplification provisions of HIPAA mandated the adoption of a standard, unique health identifier for each health care provider. The NPI Final Rule, published on January 23, 2004, established the NPI as this standard. Covered entities under HIPAA are required by regulation to use NPIs to identify health care providers in HIPAA standard transactions. This booklet contains...
Posted on March 4, 2010
On March 2, 2010, President Obama signed into law the "Temporary Extension Act of 2010." Among other things, this law extends through March 31, 2010, the zero percent update to the Medicare Physician Fee Schedule that was in effect for claims with dates of service January 1, 2010, through February 28, 2010. Consequently, effective immediately, claims with dates of service March 1 and later which...
Posted on March 4, 2010
TriWest offers more than one option to submit your referrals and authorizations. TriWest’s preferred method of submitting referrals and authorizations is online through the secure provider portal at www.triwest.com/provider.
Online Submission - Once you become a registered user of on the secure provider portal, you can access the “Learn to Submit Requests” reference materials and watch a brief...
Posted on March 4, 2010
NGS is in the process of identifying providers in Jurisdiction 13 (Connecticut and New York) who continually submit multiple duplicate claims. Providers who have a high amount of duplicate claim submissions to National Government Services will be contacted in the next few weeks. These providers will be asked to explain the reason(s) for the duplicative billing and education will be provided to...
Posted on March 4, 2010
CMS has listed the latest tests approved by the FDA as waived tests under the Clinical Laboratory Improvement Amendments of 1988 (CLIA).
CPT Code
Effective Date
Description
80101QW, G0430QW
July 1, 2009 for 80101QW, January 1, 2010 for G0430QW
Inverness Medical Innovations Signify ER Drug Screen
82274QW, G0328QW
September 9, 2009
Germaine Laboratories AimStep...
Posted on March 4, 2010
Providers who call 1-888-TRIWEST (888-874-9378) now have the ability to check detailed claims information over the phone. This new functionality gives you the ability to obtain the information you need 24/7 without the assistance of a customer service representative.
The IVR will provide information on up to five matching claims. Detailed claim and check information is given on paid and...
Posted on March 4, 2010
The revised Medicare Appeals Process brochure (January 2010), which provides an overview of the Medicare Part A and Part B administrative appeals process available to providers, physicians and other suppliers who provide services and supplies to Medicare beneficiaries, as well as details on where to obtain more information about this appeals process, is now available in downloadable format from...
Posted on March 4, 2010
The purpose of this article is to provide education on medical necessity of B-Type Natriuretic Peptide (BNP) services in response to denials noted through the NAS Medical Review department.
BNP is synthesized and released from the heart, and elevated levels may lend support to a diagnosis of abnormal ventricular function or hemodynamics. Used in conjunction with other clinical information, it may...
Posted on March 4, 2010
Medi-Cal is pleased to announce a new training product, Webinar (Web-based seminar) classes. Beginning May 2010, new training sessions will allow providers to learn from Medi-Cal trainers online. Providers will be able to efficiently communicate with trainers through streaming audio and video in a virtual classroom.
Providers will be able to view the material being presented, print documents and...
Posted on March 4, 2010
The 2010 changes for ICD-10 are in; our ICD-10 code online translation tool now reflects the updates. This allows you to convert ICD-9 codes to ICD-10 codes or vice versa. ICD-9 has been expanded from 14,025 to approximately 141,000 ICD-10 codes, and this online tool can help you map that expansion. To learn more, go to the Code Translation tool on the AAPC website.
Posted on March 4, 2010
Although enrolled in Medicare, many physicians and non-physician practitioners who are eligible to order items or services or refer Medicare beneficiaries to other Medicare providers or suppliers for services do not have current enrollment records in the Provider Enrollment, Chain and Ownership System (PECOS). A current enrollment record is one that is in the PECOS and also contains the National...
Posted on March 4, 2010
New information from the Medicare Learning Network: CMS has released two new HIPAA Version 5010 fact sheets, as well as two companion checklists, to assist providers in transitioning to 5010.
Version 5010 is the new version of the X12 standards for HIPAA transactions; version D.0 is the new version of the National Council for Prescription Drug Program (NCPDP) standards for pharmacy and supplier...
Posted on March 4, 2010
CR 6812, informs carriers and MACs about the new HCPCS codes for 2010 that are subject to, and those that are excluded from, CLIA edits. CLIA regulations require a facility to be appropriately certified for each test it performs; and moreover, to ensure that Medicare...
Posted on March 4, 2010
With less than six months before the Red Flags Rule is set to go into effect, four national organizations have requested the Federal Trade Commission (FTC) reconsider the inclusion of health professionals in the regulation.
The American Medical Association (AMA) has upheld its opinion that the FTC’s overly broad interpretation of the Fair and Accurate Credit Transactions Act of 2003 (FACT) led...
Posted on March 4, 2010
We are pleased to report that after a series of discussions with the Rate Development and Medical Policy branches of the Department of Health Care Services ( DHCS) they have informed us that they are rescinding the policy announcement that would have denied -26 or professional component billing for most clinical pathology codes in the hospital setting. The policy change did take effect for dates...
Posted on March 4, 2010
Effective for dates of service on or after March 1, 2010, CPT code 88305 (Level IV – surgical pathology, gross and microscopic examination; skin, other than cyst/tag/debridement/plastic repair) should be submitted for surgical pathology of biopsies to confirm vulvar, vaginal or genital warts. Code 88304 is no longer reimbursable for this purpose, effective for the same dates of service.
When...
Posted on March 4, 2010
Due to recent provider inquiries regarding incorrect denials of CPT codes billed with modifier 59, Cahaba ran a report to identify all claims denied as duplicates with the use of modifier 59. The report is being researched and adjustments will be made to incorrectly denied claims using an automated system. Until the claims have all been adjusted, our Clerical Error Reopening lines will not adjust...
Posted on March 4, 2010
CMS has rescinded CR 6375, "Place of Service (POS) and Date of Service (DOS) Instructions for Interpretation of Diagnostic Tests" Transmittal 1873 dated December 11, 2009, and will replace it with another CR in the future, pending further policy clarification on date of service and place of service reporting for the interpretation of diagnostic tests.