CMS announced today that although they are not moving the deadline for the new 5010 claims format which was mandatory on Jan 1, 2012, they will not enforce compliance until March 31, 2012. Essentially delaying it for three months. There has been a lot of chatter in the industry from covered business entities that they have not firmed up testing to allow for only the 5010 format on Jan 1, 2012 so if either your clearinghouse or payor are not ready yet, you may still be able to transmit claims in the old 4010 legacy format. And if you haven't had time yet to update your provider and facility zip codes, you still have time.
CMS news release can be found here: http://www.cms.gov/ICD10/Downloads/CMSStatement5010EnforcementDiscretion111711.pdf
Thursday, November 17, 2011
Tuesday, February 8, 2011
Top Medicare Denials
Noridian Medicare just released last week the top five denials for October through December.
The top five are:
Non covered because the service is not deemed medically necessary
The procedure code or modifier was invalid for that service date
Claim denied as patient can not be identified
Claim lacks the NPI of the referring or ordering physician
or NPI is invalid
Maximum benefits for time period have been exceeded
The Part B newsletter can be found at the link below:
https://www.noridianmedicare.com/provider/updates/docs/top_claim_submission_errors_Oct-Dec.pdf
What is more shocking, is that all of these reasons are easily preventable. By simply checking benefits and eligibility four of them can be eliminated and there are NPI look ups through NPPES.
We'll go more in depth on how to solve these denials in future posts or for tips on how to eliminate these denials in your office, give us a call, we'd love to help!
The top five are:
Non covered because the service is not deemed medically necessary
The procedure code or modifier was invalid for that service date
Claim denied as patient can not be identified
Claim lacks the NPI of the referring or ordering physician
or NPI is invalid
Maximum benefits for time period have been exceeded
The Part B newsletter can be found at the link below:
https://www.noridianmedicare.com/provider/updates/docs/top_claim_submission_errors_Oct-Dec.pdf
What is more shocking, is that all of these reasons are easily preventable. By simply checking benefits and eligibility four of them can be eliminated and there are NPI look ups through NPPES.
We'll go more in depth on how to solve these denials in future posts or for tips on how to eliminate these denials in your office, give us a call, we'd love to help!
Tuesday, February 1, 2011
The A-Z revenue cycle, why it doesn't work.
I remember years ago there was a commercial, I think for an investment banking firm that claimed they “make money the old fashioned way, they earned it”. Well if you are following up on outstanding a/r balances the old fashioned way, you could be losing it. It used to be that offices would print out an a/r report and then start calling on balances from A-Z. It was quickly apparent that no one ever gets to “Z”. I have even had a coworker whose last name starts with “Z” exclaim how fun he thought it was to berate offices when they would call him about a balance months after the fact. They’d be so embarrassed at their inefficiency they’d write it off. Offices thought they got smart when they would work the report in reverse every other month to make sure that "Z" got 'worked' at least every 60 days. You can imagine how happy this would make the people with last names staring with “L”. In todays world an efficient office should have a turnaround time of less than 60 days, many offices have turnaround times of 45 days or less. Often this is referred to as “days in a/r”, and is a measurement of the average time it takes from the date of service to receive payment. Anything over 60 days and you should be identifying workflow issues in your office and implementing solutions to resolve them. If you need help with your revenue cycle, give us a call, we love this stuff.
Monday, January 24, 2011
New Vaccine Admin codes
Last week I had a family practice office ask about the new vaccine admin codes that went into effect on Jan 1, 2011. They were confused on when and how you would use them.
The new codes: 90460 and 90461 have replaced the code range 90465-90468 for use when the physician provides counseling to the patients along with the vaccination. You would still use the new codes along with the code identfying the medication administered such as the code 90633 - 90634 for Heb, and 90645 for Hib, and 90680 for rotovirus.
The first new code, 90460 is used to identify the first vaccine component and 90461 is used for each for all additional components in which the physician provided administration AND counseling. 90461 is also noted as an add on code and can not be billed without 90460. Also important to note in the description is that both of the new codes are for administration and counseling in children 18 or younger as opposed to the codes they replaced that had an age limit of 8 years of age.
So what this means is if a nine year old child came in for MMR shot, and the physician provided counseling they would bill out administration for three components: measles, mumps, and rubella, which would be 90460, 90461 x 2
The American Acadmey of Pediatrics has recommended that the code 90461 is billed on one line item with the number of units rather than two sepearte line items of 90461. For more information and some FAQ's, please see their website at:
http://practice.aap.org/content.aspx?aid=2980
You would use still use 90471 and 90472 if there is NO counseling such as flu clinics where patients just walk in, get a shot, and walk out or for patients over the age of 18.
The new codes: 90460 and 90461 have replaced the code range 90465-90468 for use when the physician provides counseling to the patients along with the vaccination. You would still use the new codes along with the code identfying the medication administered such as the code 90633 - 90634 for Heb, and 90645 for Hib, and 90680 for rotovirus.
The first new code, 90460 is used to identify the first vaccine component and 90461 is used for each for all additional components in which the physician provided administration AND counseling. 90461 is also noted as an add on code and can not be billed without 90460. Also important to note in the description is that both of the new codes are for administration and counseling in children 18 or younger as opposed to the codes they replaced that had an age limit of 8 years of age.
So what this means is if a nine year old child came in for MMR shot, and the physician provided counseling they would bill out administration for three components: measles, mumps, and rubella, which would be 90460, 90461 x 2
The American Acadmey of Pediatrics has recommended that the code 90461 is billed on one line item with the number of units rather than two sepearte line items of 90461. For more information and some FAQ's, please see their website at:
http://practice.aap.org/content.aspx?aid=2980
You would use still use 90471 and 90472 if there is NO counseling such as flu clinics where patients just walk in, get a shot, and walk out or for patients over the age of 18.
Monday, January 17, 2011
AMA clarifies modifier -25 usage for wellness visits
During their symposium in Chicago in Nov the AMA clarified that in 2011 you will no longer need to append a modifier-25 to wellness visits billed with covered screening tests, however you will still need to use the modifier if you are billing the wellness exam with a separately identifiable E/M service.
They also clarified that the new subsequent observation codes (99224-99226) are designed to be reported by both the physician who initiates observation care and any other doctor who evaluates the patient. For the non-initiating doctors, the AMA states you should report consult codes for non-Medicare payers and the subsequent observation codes for Medicare
They also clarified that the new subsequent observation codes (99224-99226) are designed to be reported by both the physician who initiates observation care and any other doctor who evaluates the patient. For the non-initiating doctors, the AMA states you should report consult codes for non-Medicare payers and the subsequent observation codes for Medicare
Monday, January 10, 2011
Medicare Physician Fee Schedule changes for 2011
The Centers for Medicare & Medicaid Services (CMS) issued a 2011 Medicare Physician Fee Schedule (MPFS) Final Rule Correction Notice to revise some physician work, practice expense (PE) and malpractice (MP) relative value units (RVUs) set forth in the 2011 MPFS Final Rule, published in the Nov. 29, 2010 Federal Register.
Subsequent legislative changes occurring after the publishing of the correction notice have made additional revisions affecting Medicare payments to physicians necessary. Of particular importance is the Medicare and Medicaid Extenders Act of 2011, which President Obama signed into law Dec. 15, 2010. This Act averts the negative update to the fee schedule that would have otherwise taken effect Jan. 1 and provides a zero percent update to the MPFS for claims with dates of service Jan. 1, 2011 through Dec. 31, 2011.
While the PFS update is zero percent, there was an adjustment to the conversion factor (CF) to make the changes budget neutral. The revised CF that will go into effect on Jan. 1, 2011 is $33.9764.
For more information you can view the transmittal here:
http://www.cms.gov/transmittals/downloads/R828OTN.pdf
Subsequent legislative changes occurring after the publishing of the correction notice have made additional revisions affecting Medicare payments to physicians necessary. Of particular importance is the Medicare and Medicaid Extenders Act of 2011, which President Obama signed into law Dec. 15, 2010. This Act averts the negative update to the fee schedule that would have otherwise taken effect Jan. 1 and provides a zero percent update to the MPFS for claims with dates of service Jan. 1, 2011 through Dec. 31, 2011.
While the PFS update is zero percent, there was an adjustment to the conversion factor (CF) to make the changes budget neutral. The revised CF that will go into effect on Jan. 1, 2011 is $33.9764.
For more information you can view the transmittal here:
http://www.cms.gov/transmittals/downloads/R828OTN.pdf
Monday, January 3, 2011
EHR Incentive Registration
The Medicare and Medicaid EHR Incentive Program Registration and Attestation System portal went live today, although not all states are ready for Medicaid registration.
The portal allows eligible hospitals and professionals to register and participate in meeting Stage 1 meaningful use criteria. Participants are being urged to register even if do not have an enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS). They are also urged to register even if their EHR has not yet been certified. A link to the portal can be found at the bottom of this page.
To use the portal, Eligible Professionals (EPs) participants must have an active National Provider Identifier (NPI) and a National Plan and Provider Enumeration System (NPPES) Web user account. EPs will use their NPPES user ID and password to log into the registration system. Eligible Hospitals registering on the system an active NPI is also required. Users working on behalf of an Eligible Hospital must have an Identity and Access Management system Web user account and be associated to an organization NPI to register.
From the portal there is also a link to the CMS website where provides can access user guides for registration and attestation with information about completing modules, a list of EHR technology that is certified for the program, specification sheets with additional information on each meaningful use objective, and other general resources.
https://ehrincentives.cms.gov/hitech/login.action
The portal allows eligible hospitals and professionals to register and participate in meeting Stage 1 meaningful use criteria. Participants are being urged to register even if do not have an enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS). They are also urged to register even if their EHR has not yet been certified. A link to the portal can be found at the bottom of this page.
To use the portal, Eligible Professionals (EPs) participants must have an active National Provider Identifier (NPI) and a National Plan and Provider Enumeration System (NPPES) Web user account. EPs will use their NPPES user ID and password to log into the registration system. Eligible Hospitals registering on the system an active NPI is also required. Users working on behalf of an Eligible Hospital must have an Identity and Access Management system Web user account and be associated to an organization NPI to register.
From the portal there is also a link to the CMS website where provides can access user guides for registration and attestation with information about completing modules, a list of EHR technology that is certified for the program, specification sheets with additional information on each meaningful use objective, and other general resources.
https://ehrincentives.cms.gov/hitech/login.action
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