Posted on August 13, 2010
If you are a physician or non-physician practitioner who is enrolled in Medicare, or who is planning to enroll in Medicare, it is important that you protect your Medicare enrollment information from getting into the hands of dishonest and unscrupulous people. CMS Medicare Learning Network (MLN) has released Medicare Fee-For-Service (FFS) Physicians and Non-Physician Practitioners: Protecting Your...
Posted on August 13, 2010
Traditionally, most physicians have enrolled in the Medicare program to furnish covered services to Medicare beneficiaries. However, with the implementation of Section 6405 of the Affordable Care Act, some physicians will need to enroll in the Medicare program for the sole purpose of certifying or ordering services for Medicare beneficiaries.
In the process of implementing the provisions...
Posted on August 13, 2010
Effective July 21, 2010, the interest rate for-overpayments and underpayments will be 11.00 percent. The Department of the Treasury has notified the Department of Health and Human Services that the PCR rate will be 11.00 percent.
Posted on August 13, 2010
The Interim Final Rule for Breach Notification for Unsecured Protected Health Information, issued pursuant to the Health Information Technology for Economic and Clinical Health (HITECH) Act, was published in the Federal Register on August 24, 2009, and became effective on September 23, 2009. During the 60-day public comment period on the Interim Final Rule, HHS received approximately...
Posted on August 13, 2010
The Department of Health and Human Services (HHS) issued a notice of proposed rulemaking today to modify the Privacy, Security, and Enforcement Rules issued pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The proposed modifications to the HIPAA Rules issued today include provisions extending the applicability of certain of the Privacy and Security Rules’...
Posted on August 13, 2010
This new MLN product explains how to look up Medicare code pair edits and Medically Unlikely Edits (MUEs). NCCI tools can help providers avoid coding and billing errors and subsequent payment denials. If you want to become familiar with the "National Correct Coding Initiative Policy Manual for Medicare Services" and the tools on the NCCI website, this is your best resource! Go to...
Posted on August 13, 2010
As a health care provider subject to the privacy and security requirements under the Health Insurance Portability and Accountability Act of 996 (HIPAA) and/or under State law, you must safeguard patients’ personally identifiable health information. If you receive a remittance advice on a Medicare beneficiary who’s not your patient, you should 1) destroy it and 2) report it to your fiscal...
Posted on August 13, 2010
The J1 Medical Review Department will be performing service specific pre-pay probe reviews of laboratory services in the three Jurisdiction 1 regions: Northern California, Southern California and Nevada/Hawaii.
These reviews will focus on laboratory codes 80101, 80102, 80154, 80299, 82306, 83898, 83925, 86706 and 88319.
80101 Drug screen, qualitative; single drug class method, each...
Posted on August 13, 2010
Recent Comprehensive Error Rate Testing (CERT) analysis indicates increased errors when billing Prothrombin Time (PT). The PT must meet medical necessity criteria, even when done as part of a coagulation clinic or “incident to” other services.
Medicare pays for services based on medical necessity. These tests must be:
Consistent with symptoms or diagnosis of the illness or injury...
Posted on August 13, 2010
Recent Comprehensive Error Rate Testing (CERT) analysis indicates increased errors when billing Urinalysis automated (UA), with microscopy CPT® 81001. Upon medical review of the documentation submitted, the physician written order indicates UA test but does not indicate microscopy. Appropriate billing based on testing ordered is CPT® 81003. Submitting a claim for diagnostic tests without the...
Posted on August 13, 2010
On July 21, 2010, CMS notified Noridian Administrative Services (NAS) that it would consolidate the Jurisdiction 2 and Jurisdiction 3 workloads and Medicare Administrative Contractor (MAC) contracts and issue a new request for proposal (RFP).
CMS has decided to cancel the J2 A/B MAC procurement and consolidate the J2 and J3 workloads into a new RFP that will be completed in the near future...
Posted on August 13, 2010
During the first quarter of 2010, 158 CERT errors were assessed for all Part B contracts within Highmark Medicare Services (HMS). Of those 158 errors, 77 errors were due to insufficient documentation (error code 21), 40 were due to incorrect coding (error code 31), 38 were due to medical necessity (error code 25), and 3 was due to improper documentation submitted to the CERT contractor (...
Posted on August 13, 2010
New York Medicaid policy requires that each provider annually certify their connection with their
Electronic Transmitter Identification Number (ETIN). If the certification is not renewed annually,
claims and other transactions will be rejected on the expiration date.
During each 12-month period, eMedNY distributes two renewal notices accompanied by a preprinted
certification...
Posted on August 13, 2010
Recent Comprehensive Error Rate Testing (CERT) findings show an increase in denials and recoupment due to the lack of a legible identifier for services provided and/or ordered in medical record documentation review. NAS is therefore reprinting information for the NAS provider community. The emphasis of this information is to educate providers on the necessity of having legible and...
Posted on August 13, 2010
Modifications were recently made to the Medicaid billing policy for HIV drug resistance testing in response to Office of State Comptroller (OSC) recommendations to prevent overutilization for such testing.
New York Medicaid currently covers up to three HIV genotypic (87901) and HIV phenotypic (87903) drug resistance tests in any combination for beneficiaries within a 365 day period.
For...
Posted on August 13, 2010
Outpatient claims can now be submitted with valid National Uniform Billing Code (NUBC) revenue codes. Revenue codes have not been required for outpatient billing in the past. Beginning with dates of service on July 1, 2010 and forward, the Medi-Cal system has been remediated so that outpatient claims can accept revenue codes. As a result:
EAPC claims must include the required...
Posted on August 13, 2010
Jon Leibowitz, the head of the Federal Trade Commission (FTC), tells AMA delegates that although the agency is delaying enforcement of the security rule, it is Congress' responsibility to exempt physicians from it.
Physicians should not be required to follow the so-called red flags rule that requires anyone offering credit to develop and implement written identity theft prevention and...
Posted on August 13, 2010
According to the TRICARE Policy Manual, Chapter 6, Section 1.1, Oncotype DX (S3854) is not a covered TRICARE benefit due to the lack of U.S. Food and Drug Administration status. If CPT code S3854 is submitted, the claim will be denied. Providers also should not submit a claim for this with an unlisted code.
Posted on August 13, 2010
A recently launched federal website, www.healthcare.gov, provides consumers with information about private and public health coverage options, tailored specifically for their needs in a single, easy-to-use tool. In addition, the website will be a one-stop-shop for information about the implementation of the Affordable Care Act and other health care resources. The website will connect...
Posted on June 30, 2010
On June 25, 2010, President Obama signed into law the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.” This law establishes a 2.2 percent update to the Medicare Physician Fee Schedule (MPFS) payment rates retroactive from June 1 through November 30, 2010. The Centers for Medicare...