USA Today provides an interactive timeline that boils down the 2,700 page Health Care Reform Bill into easy-to-understand dates. While many provisions start in 2010 various provisions won’t take effect until 2018. Here are revision dates that will impact everyone: 2010 Temporary high-risk insurance pool: A $5 billion pool would be created in June to provide health to individuals who have pre-...
The American Medical Association (AMA) today launched a new online resource that will help thousands of physicians file claims in the record-breaking settlement reached in the AMA legal victory against UnitedHealth Group—the nation’s largest health insurer. More than $350 million is available to compensate physicians and their patients for 15 years of artificially low payments for out-of-network...
Effective for dates of service on or after May 1, 2010, the ICD-9-CM diagnosis codes for certain pathology services have been updated to reflect the highest specificity. Previous ICD-9-CM Code(s) New ICD-9-CM Code(s) V70 Code deleted V72.1 V72.11, V72.12 and V72.19 795.0 795.00 070.20 – 070.9 070.20 –...
Effective for dates of service on or after May 1, 2010, CPT code 83518 (immunoassay for analyte other than infectious agent antibody or infectious agent antigen, qualitative or semiquantitative; single step method [eg, reagent strip]) is no longer considered a Clinical Laboratory Improvement Amendments (CLIA)-waived test. Therefore, providers can no longer bill code 83518 with a QW modifier (a...
ICD-9-CM diagnosis codes 151.0 – 151.9 were incorrectly listed as codes to bill in conjunction with CPT code 86304 (immunoassay for tumor antigen, quantitative, CA 125). The correct codes are: 151.0, 151.1, 151.2, 151.3, 151.4, 151.8 and 151.9. CPT code 86304 is reimbursable only when billed in conjunction with ICD-9-CM diagnosis codes listed in the provider manual Pathology: Chemistry section.
Effective for dates of service on or after May 1, 2010, HCPCS code S3820 (complete BRCA1 and BRCA2 gene sequence analysis for susceptibility to breast and ovarian cancer) is a once-in-a-lifetime procedure and requires a Treatment Authorization Request (TAR). A TAR for HCPCS code S3820 requires documentation of one or more of the following numbered criteria....
Gender restrictions for males receiving either gonadotropin follicle stimulating hormone (FSH) (CPT code 83001) or gonadotropin luteinizing hormone (LH) (code 83002) have been updated to include ICD-9-CM codes in the range 752.51 – 752.69 or 752.81 – 752.89.
Effective for dates of service on or after May 1, 2010, the diagnosis code range for CPT code 86304 (immunoassay for tumor antigen, quantitative, CA 125) has been expanded to include ICD-9-CM diagnosis codes 233.0 – 233.39. Providers are reminded to always bill to highest specificity.
Effective for dates of service on or after May 1, 2010, ICD-9-CM diagnosis code ranges for CPT code 82728 (ferritin) have been expanded to include the following codes: 001.0 – 009.3 608.3 010.00 – 018.96 626.0 – 627.9 042.(no change) 648.00 – 648.94 070.0 – 070.9 698.0 – 698.9 (no...
The ICD-9-CM diagnosis code range for CPT code 83001 (gonadotropin; follicle stimulating hormone [FSH]) or 83002 (...luteinizing hormone [LH]) has been expanded to include codes 303.90 – 303.93. This policy is effective for dates of service on or after May 1, 2010.
Effective for dates of service on or after May 1, 2010, CPT code 84146 (prolactin level testing) is reimbursable when billed in conjunction with one of the following updated ICD-9-CM diagnosis codes: 242.90, 242.91, 250.40 – 250.43, 403.00 – 403.91, 404.00 – 404.93, 405.01 – 405.99 and 676.00 – 676.94.
The chart below clarifies ICD-9-CM diagnosis codes allowable on claims for CPT code 83009 (Helicobacter pylori, blood test analysis for urease activity), code 83013 (Helicobacter pylori; breath test analysis for urease activity), code 83014 (Helicobacter pylori; drug administration), code 87338 (infectious agent antigen detection by immunofluorescent technique; Helicobacter pylori; stool)...
Effective for dates of service on or after May 1, 2010, the ICD-9-CM code requirement for billing with CPT code 83876 (myeloperoxidase [MPO]) has been expanded to include 410.00 – 414.9.
Providers are reminded that attachments are required when billing Medi-Cal for CPT codes 86920 (compatibility test each unit; immediate spin technique), 86921 (incubation technique), 86922 (antiglobulin technique) and 86923 (electronic). Codes 86920, 86921, 86922 and 86923 are all “By Report” codes so attachments are necessary in order for the Department of Health Care Services (DHCS) consultant...
On March 1, 2010, CMS issued Joint Signature Memorandum/Technical Direction Letter (JSM/TDL-10162) to advise all Medicare claims processing contractors that CMS had divided the Medicare claims processing contractors into two banking workloads. Workload A was awarded to US Bank. Workload B was awarded to JP Morgan Chase. Workload A (US Bank) consists of: CIGNA Government Services Highmark...
Medicare requires that medical record entries for services provided/ordered be authenticated by the author. The method used shall be a hand written or an electronic signature. Stamp signatures are not acceptable. Patient identification, date of service, and provider of the service should be clearly identified on the submitted documentation. (Medicare Internet Only Manual 100-8, Ch 3, sect 3.4.1.1...
Medicaid is dedicated to protecting your personal information against fraud and scams. You can help protect your license and personal bank accounts by being cautious in giving out your own personal information such as first name, last name, business name, email address, userid/password, financial information (credit card, bank account number, PIN), social security number, and driver's license...
Effective for dates of service on or after April 1, 2010, CPT-4 code 87184 (susceptibility studies, antimicrobial agent; disk method, per plate [12 or fewer agents]) is a new Presumptive Eligibility (PE) benefit.
NHIC would like to remind providers of the current Signature Requirements as stated in Chapter 3 (3.4.1.1 ) of the Program Integrity Manual: Medicare requires a legible identifier for services provided/ordered. The method used shall be hand written or an electronic signature (stamp signatures are not acceptable) to sign an order or other medical record documentation for medical review purposes...
What should you do if you disagree with your RAC overpayment determination? The below chart breaks down the different options providers have when disputing a RAC overpayment determination. Provider Options - RAC Overpayment Determination Discussion Period Rebuttal Redetermination Which option should I use? The discussion period offers the opportunity for the provider to...