Billing News Sep 2009



HITECH Breach Notification Interim Final Rule

  • September 30, 2009

HHS issued regulations requiring health care providers, health plans, and other entities covered by the Health Insurance Portability and Accountability Act (HIPAA) to notify individuals when their health information is breached. "Breach" is defined in the Act as "the unauthorized acquisition, access, use, or disclosure of protected health...

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Claims Submitted for Items or Services Furnished to Medicare Beneficiaries in State or Local Custody under a Penal Authority and Examples of Application of Government Entity Exclusion

  • September 30, 2009

This article is based on Change Request (CR) 6544, which describes special conditions that must be met in order for Medicare to make payment for services provided to individuals or groups of individuals who are in the custody of the police or other penal authorities or in the custody of a government agency under a penal statute or rule. This CR...

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Reminders from the CERT Documentation Contractor

  • September 30, 2009

Livanta, the CERT Documentation Contractor (CDC) had asked contractors to educate their provider community on the following items: The CDC is encouraging providers who have voluminous pages of medical records to submit medical records electronically via CDs either in .pdf or .tif format. To protect the electronic records please...

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Clearing up the Confusion on Copying Military ID Cards

  • September 30, 2009

On August 10, 2009, U.S. Army North published a Force Protection Advisory (0050-09-FPA) entitled Photocopying of Military Identification Cards. It stated "Recent incidents regarding the photocopying of military identification cards and common access cards (CAC) by commercial establishments to verify military affiliation or provide government rates...

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Blue Cross Blue Shield Settlement

  • September 30, 2009

The final appeal in the Blue Cross Blue Shield Settlement was dismissed on June 12, 2009 and as such, the settlement has been finalized. The settlement administrator mailed the settlement checks to class members on July 22, 2009. * CODING PROVISIONS IN BLUE CROSS BLUE SHIELD ASSOCIATION SETTLEMENT TAKE EFFECT JANUARY 21, 2009 The...

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Lab sued for Fraud by New Jersey Blue Cross Plan

  • September 30, 2009

On June 25, 2009 Horizon Blue Cross Blue Shield of New Jersey filed a civil suit in New Jersey Superior Court against Biodiagnostic Laboratory Services of Parsippany, N.J. for allegedly submitting more than $14 million in fraudulent health insurance claims to Horizon between 2005 and June 2009 (Horizon Blue Cross Blue Shield of New Jersey v....

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New Benefits for Cancer Detection Programs: Every Woman Counts

  • September 30, 2009

Effective for dates of service on or after August 1, 2009, the following services are new benefits for Cancer Detection Programs: Every Woman Counts. CPT-4 Code Description 88307 Level V, gross and microscopic examination, requiring microscopic evaluation of surgical margins 88360 Morphometric analysis, tumor immunochemistry...

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Laboratory Procedures NCCI Policy Update

  • September 30, 2009

Effective for dates of service on or after October 1, 2009 the following changes are in effect: CPT-4 codes 83890 - 83914 are not reimbursable when billed with codes 87470 - 87801 or 87901 - 87904, for the same date of service, recipient and provider, but may be billed separately with a National Correct Coding Initiative (NCCI) associated...

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