Billing News Mar 2010



Revised Clinical Laboratory Fee Schedule and ZIP Code File to Include New Kansas Payment Locality Structure

  • March 4, 2010

This article is based on CR 6787 which instructs the Medicare contractors to incorporate an additional Kansas payment locality in the Clinical Laboratory Fee Schedule (CLFS) into their system to ensure correct pricing for certain laboratory claims submitted with a “90” modifier for services performed in the Kansas payment localities. CMS...

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CPT Code 88305 Used to Bill for Genital Wart Surgical Pathology

  • March 4, 2010

Effective for dates of service on or after March 1, 2010, CPT code 88305 (Level IV – surgical pathology, gross and microscopic examination; skin, other than cyst/tag/debridement/plastic repair) should be submitted for surgical pathology of biopsies to confirm vulvar, vaginal or genital warts. Code 88304 is no longer reimbursable for this purpose...

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Medicare Appeals Process Brochure

  • March 4, 2010

The revised Medicare Appeals Process brochure (January 2010), which provides an overview of the Medicare Part A and Part B administrative appeals process available to providers, physicians and other suppliers who provide services and supplies to Medicare beneficiaries, as well as details on where to obtain more information about this appeals...

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HIPAA Version 5010 - Taking Electronic Data Interchange to the Next Level

  • March 4, 2010

New information from the Medicare Learning Network: CMS has released two new HIPAA Version 5010 fact sheets, as well as two companion checklists, to assist providers in transitioning to 5010. Version 5010 is the new version of the X12 standards for HIPAA transactions; version D.0 is the new version of the National Council for Prescription Drug...

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Units of Service validation begins on December 15, 2009

  • March 4, 2010

Units of Service validation editing for procedure codes submitted from professional providers (837P or 1500 Health Insurance Claim Form) begins on the evening of December 15, 2009. Although Blue Cross and Blue Shield of Minnesota and Blue Plus are not following Medicare’s Medically Unlikely Edits (MUE), this is similar to MUEs where the verbiage...

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Medi-Cal Webinar Classes

  • March 4, 2010

Medi-Cal is pleased to announce a new training product, Webinar (Web-based seminar) classes. Beginning May 2010, new training sessions will allow providers to learn from Medi-Cal trainers online. Providers will be able to efficiently communicate with trainers through streaming audio and video in a virtual classroom. Providers will be able to view...

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CSP Successful in Reversing Medi-Cal Decision to Deny Professional Component Billing for Clinical Pathology

  • March 4, 2010

We are pleased to report that after a series of discussions with the Rate Development and Medical Policy branches of the Department of Health Care Services ( DHCS) they have informed us that they are rescinding the policy announcement that would have denied -26 or professional component billing for most clinical pathology codes in the hospital...

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Claims Inquiry Process Clarifications

  • March 4, 2010

Underpayment/Overpayment Adjustments and Voids A Claims Inquiry Form (CIF) adjustment should be used to correct both underpayments and overpayments. However, this transaction type is different than requesting a full payment recovery, which is a void. A CIF adjustment is a one-step process. If requesting an adjustment for an underpaid or overpaid...

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