Thursday, December 01, 2011
On Monday, November 7, 2011, the Medicaid electronic health record (EHR) incentive program was launched in Arkansas, Delaware, Montana, New Jersey, New York, and North Dakota. This means that eligible professionals (EPs) and eligible hospitals in these six states will be able to complete their incentive program registration.
Friday, November 18, 2011
To facilitate prompt and accurate credit of unsolicited monies or voluntary refunds to Medicare, a Return of Monies form has been developed. Please use the Return of Monies form (8322) for Part B if you receive a Medicare payment in error.
Monday, November 22, 2010
During the third quarter, 52 CERT errors were assessed for all Part B contracts within J12. Of those 52 errors, 18 errors were due to insufficient documentation, 5 were due to medical necessity and 29 were due to incorrect coding.
Wednesday, September 01, 2010
To assist electronic billing customers with error messages received on the electronic reports, an
interactive 1450 (UB-04) form has been developed as a crosswalk. This crosswalk is an interactive feature that displays the appropriate loops, segments, and qualifier detail when clicking on each block of the 1450 (UB-04) sample claim form. A crosswalk chart is also available to provide a complete list of the crosswalk information.
Friday, 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 (error code 16).
The Part B CERT errors that were received for Highmark Medicare Services during this quarter remain relatively unchanged from the last quarter.
Wednesday, March 31, 2010
As a result, the Medical Society of New Jersey (MSNJ) has filed a compliance dispute against Horizon alleging multiple violations of the national class-action settlement agreement concerning these modifiers.
The Horizon BCBSNJ memo announced that this change will become effective on May 17, 2010, and will recognize services submitted with a variety of modifiers as “nonstandard” and “not performed” or pay for the services at significantly discounted amounts.
Wednesday, March 31, 2010
OVA1™ is an FDA-cleared qualitative serum test that combines the biomarker values of five immunoassays, using a proprietary algorithm, to further assess the likelihood that an ovarian mass is malignant, in women whose pre-surgical assessment did not indicate malignancy.
Highmark Medicare Services will cover OVA1™ in keeping with the FDA-cleared indication until such time that a Local Coverage Determination is developed and implemented. OVA1™ is currently indicated for women who meet the following criteria:
Thursday, March 04, 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 Provider Identifier (NPI). The lack of a current enrollment record in the PECOS is a result of not having submitted any enrollment information updates since November 2003.
Thursday, March 04, 2010
During the fourth quarter, 148 CERT errors were assessed for all Part B contracts within J12. Of those 148 errors, 66 errors were due to insufficient documentation (error code 21), 47 were due to medical necessity (error code 25), 33 were due to incorrect coding (error code 31) and 2 were due to service billed were not rendered (error code 41).
Monday, February 08, 2010
Medicare Part B covers a specimen collection fee and travel allowance for a laboratory technician to draw a specimen from either a nursing home patient or homebound patient. There are two codes: P9603 for a per mile trip basis or code P9604 for a flat rate trip basis where the average round trip is generally less than 20 miles (or an average of 10 miles per leg of the trip).
Thursday, January 28, 2010
National Government Services, Inc. for New York and New Jersey Medicare Part B will retire the Local Coverage Determinations (LCD) listed below, effective May 31, 2007. Based on analysis of their effectiveness, these LCDs are no longer useful for prepay, postpay, or educational purposes.
Retired Local Coverage Determinations (LCD) May 31, 2007
LCD Title
NY LCD Number
Thursday, January 07, 2010
As you should know, the CERT program consists of a random sample of Medicare claims selected each month which undergo an independent medical review process whereby the claims data are adjudicated against the medical records of the physician/provider. The results are analyzed and used to produce annualized estimates of the dollars paid incorrectly for each of the 15 Medicare Jurisdictions as well as Medicare nationally. This is done by statistically extrapolating the findings from the sample to the entire universe of Medicare claims.
Thursday, January 07, 2010
Medicare has identified a recent increase in the number of CERT errors attributed to the lack of physician orders for diagnostic tests. A diagnostic test includes all diagnostic x-ray tests, all diagnostic laboratory tests, and other diagnostic tests furnished to a beneficiary! An “order” is a communication from the treating physician/practitioner requesting that a diagnostic test be performed for a beneficiary.