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    • August 31, 2012

    Beginning August 13, 2012, CGS will send all overpayment letters (demand letters) in light blue envelopes. Requests for repayment of Medicare funds are time-sensitive, and they hope that this change in envelope color will help you quickly and easily identify these requests. ï CGS uses the Healthcare Integrated General Ledger Accounting... more

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    • August 31, 2012

    Diversified Collection Services (DCS) is the Recovery Audit Contractor for the states of Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont. The following issue concerning Hepatic Function Panel Testing is under review for laboratories in CT and... more

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    • 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. The majority of the errors for insufficient documentation were related to the fact that the medical record... more

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    • September 1, 2011

    CMS uses the Comprehensive Error Rate Testing (CERT) program to measure and improve the quality and accuracy of Medicare claims submission, processing and payment. Under this program, numerous randomly selected claims are reviewed each year. The CERT Claim Identifier Tool has been designed to help Medicare providers locate information... more

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    • June 27, 2011

    BlueCross BlueShield of South Carolina1 has acquired CIGNA Government Services, LLC. While very little will change as a result of the acquisition, they are changing their name. Effective June 1, 2011, they will now be called CGSSM, LLC. All the same services, features, education, addresses, telephone numbers, and claim submission processes... more

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    • May 27, 2011

    The National Correct Coding Initiative (NCCI) consists of codes that have paired edits. When the two codes are billed together the edits are in place to prevent improper payment for claims submitted together for Part B services. CMS has developed NCCI edits-physicians, NCCI edits-outpatient, and Medically Unlikely Edits (MUE) to help protect the... more

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    • July 24, 2012

    If you applied for a Z-Code Identifier, the on line test registry is now available. On July 16, 2012 Palmetto J1 launched the MolDx Program Online Registry and on July 23, 2012 will launch the Automated Technical Assessment portion. The following functions are available once you access the registry: • Review specific test information • Review... more

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    • July 24, 2012

    In May 2012 TrailBlazer implemented an edit for CPT codes 80074© (acute hepatitis panel) and 80076© (hepatic function panel) to address a high Comprehensive Error Rate Testing (CERT) error rate. Since then, they have received several inquiries about the electronic submission of orders for these labs and the necessity of a physician signature for... more

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