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Industry News: Florida

Thursday, September 01, 2011

Florida Medicaid requires all initial or renewing provider applicants to submit fingerprints for purposes of obtaining a criminal history record check unless they meet one of the exemptions as described in the statute.

New or renewing applicants to Florida Medicaid who were fingerprinted by the Department of Health (DOH) within the previous twelve (12) months may submit proof of that screening in lieu of fingerprints with their new or renewing application to Florida Medicaid.

Friday, July 29, 2011

In May 2011, First Coast Service Options (FCSO) began accepting fax requests for reopenings of claims with dates of service in January-May 2010 to be reprocessed under the Affordable Care Act (ACA). Since that time, mass adjustments have been executed that automatically reprocess claims where the billed amount was greater than the new (post-ACA) allowances. To reduce workloads and costs associated with manually reprocessing faxed requests, CMS has authorized contractors to stop performing manual reopening of those claims that are scheduled to be mass-adjusted.

Tuesday, March 01, 2011

First Coast Service Options has seen an increase in the number of Comprehensive Error Rate Testing (CERT) errors related to CPT codes 85025 and 85027. Based on review of documentation by the CERT review contractor, findings have revealed that this service is incorrectly coded.

These CPT codes are defined as:

• CPT 85025 -- complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count.
• CPT 85027 -- complete (CBC) automated (Hgb, Hct, RBC, WBC and platelet count)

Monday, November 22, 2010

Medicare will only pay for tests that meet Medicare’s reasonable and necessary guidelines. Medicare may deny payment for a test that the physician believes is appropriate but does not meet Medicare’s definition of “medical necessity.”

The Office of the Inspector General (OIG) recommends that laboratories and laboratory companies take the following precautions to help ensure that requirements for medical necessity are met:

Friday, October 01, 2010

Florida Medicaid announced the October 1, 2010, system integration of the National Correct Coding Initiative (NCCI) in the September 13, 2010, Provider Alert titled: “Medicaid Implements National Correct Coding Initiative (NCCI).” As stated in the provider alert, NCCI will identify and edit Medicaid claims for coding that does not adhere to guidelines established by CMS. NCCI is comprised of edits for services that are mutually exclusive; component code edits; and units billed edits. The edits will apply to professional and outpatient claims only.

Wednesday, September 01, 2010

In order to enhance Medicaid efforts to ensure that the program is providing quality, affordable health care for all Americans, the United States Congress included provisions in the Patient Protection and Affordable Care Act of 2009 that mandates changes in Medicaid rules for enrolling providers and submitting claims. Starting January 1, 2011, Medicaid will require that all providers who must obtain an NPI include their NPI on all claims submitted to Medicaid. This will include all claims from these providers, whether submitted on paper or electronically.

Wednesday, September 01, 2010

All members of the jurisdiction 9 (J9) provider community (Florida, Puerto Rico, and the U.S. Virgin Islands) can take advantage of the Provider Data Summary report (PDS) portal to help improve the accuracy and efficiency of their Medicare billing operations.

PDS reports help providers identify and correct recurring billing issues:

Friday, June 25, 2010

An article published in the January 2010 Medicare B Update (page 51) of the publication may have led providers to a misunderstanding regarding the correct use of modifier CB (Service ordered by a renal dialysis facility [RDF] physician as part of the ESRD (end-stage renal disease) beneficiary’s dialysis benefit, is not part of the composite rate, and is separately reimbursable).

Monday, May 03, 2010

CMS requires that any Medicare service provided or ordered must be authenticated by the author -- the one who provided or ordered that service. Authentication may be accomplished through the provision of a hand-written or an electronic signature; however, stamp signatures are unacceptable.

Wednesday, March 31, 2010

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 number. We will never request personal credit card or bank account information over the telephone.

Thursday, February 04, 2010

Florida Medicaid has published notice that effective for dates of service beginning on April 01, 2005, Medicaid is implementing a 10% reduction for all Medicaid independent laboratory fees. The reduction was mandated by the Florida Legislature because no contract will be in place by April 01, 2005.

Tuesday, February 02, 2010

First Coast Service Options Inc. (FCSO) has been made aware of an issue regarding providers receiving denials when billing CPT code 84295 (Sodium; serum, plasma or whole blood) and ICD-9-CM code 585.6 (End-stage renal disease) for hemodialysis patients when modifiers CB and CF and several other modifiers identified for the automated multichannel chemistry tests (AMCC) were appended that noted the service rendered were outside the composite rate.

Wednesday, December 02, 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 providers treating Medicaid recipients to access up to 18 months of Medicaid claims history, helping them make better-informed decisions about their patients.

Wednesday, December 02, 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.