Noridian incorrectly denies 300,000 claims for E&M services Last fall, the Centers for Medicare and Medicaid Services (CMS) experienced some editing issues with new patient E&M codes that resulted in incorrect claim denials. These problems started in October 2013, and was thought to have been corrected in late January 2014. The California Medical Association recently learned, however, that some claims continued to be paid incorrectly through July 15, 2014. Noridian, California's Medicare contractor, in January began making mass adjustments and correcting claims subjected to overpayment recovery. Unfortunately, while implementing the corrections, Noridian inadvertently subjected established patient E&M codes ... August 13, 2014 Medicare Medicare, Noridian, Billing/Coding 0 0 Comment Read More »
CMS temporarily takes Sunshine Act system offline The Centers for Medicare and Medicaid (CMS) announced yesterday that the verification system for financial interactions tracked under the Physician Payments Sunshine Act system has been taken offline temporarily because of physician complaints of inaccuracies. Under the Sunshine Act, drug and medical device manufacturers are required to report their financial interactions with licensed physicians – including consulting fees, travel reimbursements, research grants and other gifts. Any payments, ownership interests and other “transfers of value” will be reported to CMS for publication in an online database. CMS had opened the system for ... August 8, 2014 Medi-Cal, Medicare CMS, Physician Payment Sunshine Act, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
CMS offering webcasts on ICD-10 clinical documentation requirements The Centers for Medicare and Medicaid Services (CMS) is offering a series of webcasts for small physician practices regarding clinical documentation requirements instituted for the transition to ICD-10. Available webcasts in the ICD-10 Documentation and Coding Concepts series include orthopedics, cardiology, pediatrics, obstetric and gynecology, and family practice and internal medicine. For more information, future events and to access the webcasts, please visit www.roadto10.org (click “webcasts” in the left margin). August 8, 2014 Medi-Cal, Medicare Centers for Medicare and Medicaid Services, ICD-10, Webinars, CMS 0 0 Comment Read More »
No on Proposition 46 campaign releases first video online Today, the “No On 46” campaign released its first campaign video on multiple online platforms. Titled “The Truth about Proposition 46,” the two-minute video features real practicing physicians and medical students from across the state discussing the flaws, costs and potential harmful consequences to patients and California’s health care system, if Prop. 46 were to pass. The video highlighted many of Prop. 46’s major flaws including, but not limited to, the fact that the initiative is written and paid for almost exclusively by trial lawyers who will personally profit from the ... August 8, 2014 General Professional Liability, MICRA 0 0 Comment Read More »
Hospitals can now request IMQ physician surveyors for accreditation surveys The California Medical Association’s (CMA) Institute for Medical Quality (IMQ) recently signed a contract with The Joint Commission that allows California acute care hospitals to choose whether they want an IMQ physician surveyor to participate in their accreditation surveys. Hospitals with survey anniversary dates in 2015 have until August 15 to indicate their selection. If they do not actively request an IMQ surveyor, IMQ will not participate on their survey. Since the 1970s, IMQ has participated in hospital licensure and accreditation surveys in partnership with the Joint Commission and the ... August 8, 2014 General IMQ, Institute for Medical Quality, Joint Commission, Hospital Accreditation 0 0 Comment Read More »
Cal MediConnect lawsuit unsuccessful Last week, the Sacramento Superior Court denied a request to delay implementation of the Cal MediConnect project. In a last minute challenge to the program, the Los Angeles County Medical Association (LACMA) joined a coalition of plaintiffs, including three Los Angeles independent living centers, to file a lawsuit in Sacramento Superior Court to stop the implementation of the project. The Cal MediConnect project was authorized by the state in July 2012 in an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities. ... August 8, 2014 Medi-Cal, Medicare Dual Eligible, Medi-Cal, Medicare, Cal MediConnect 0 0 Comment Read More »
How to file effective second bill reviews for workers' compensation This is the second in a two-part series focusing on coding, compliance and documentation issues relating specifically to Workers’ Compensation billing. This month’s tip comes from Catherine Montgomery, the founder and CEO of DaisyBill, which offers software solutions for workers’ compensation medical billing. Previously discussed was the importance of filing second bill reviews (SBR) for workers’ compensation medical bills, even if the underpayment is small. In the increasingly unforgiving workers’ comp billing environment , it is incumbent upon providers to make sure that billing staff or third-party billers correctly submit ... August 8, 2014 General Practice Resources, Workers Compensation, Coding and Documentation 0 0 Comment Read More »
Fall 2015 is new implementation date for ICD-10 The Centers for Medicare and Medicaid Services (CMS) last week published a final rule, officially setting Oct. 1, 2015, as the new ICD-10 implementation deadline. The bill including a temporary patch of the sustainable growth rate (SGR), passed by Congress in April also included a delay in ICD-10 implementation, which was previously to begin on Oct. 1, 2014. The new deadline allows providers, payors and others in the health care industry time to ensure their systems and business processes are ready to go on Oct. 1, 2015. ICD-10 (The International ... August 8, 2014 Medi-Cal, Medicare CMS, ICD-10, SGR, Sustainable Growth Rate, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
Noridian offering webinars for practices Noridian, the Medicare Administrative Contractor for California, has scheduled a series of one-hour webinars during the month of August. Topics include common errors, global surgery and a series of three webinars titled “Climbing The Ladder To Success.” (For details on each workshop, click on the title.) Continuing education units are offered for most workshops. August 8, 2014 Medicare Noridian, Webinars, Medicare 0 0 Comment Read More »
Anthem Blue Cross begins medical chart reviews for exchange patients In July, Anthem Blue Cross began chart reviews on enrollees who purchased an individual exchange or mirror product. Similar to the Medicare Risk Adjustment Audit process, and as required by the Affordable Care Act (ACA), the audit is designed to identify the health status and demographic characteristics of exchange/mirror product enrollees. Blue Cross will review diagnosis code data obtained from the medical records of exchange patients. This is not a typical audit on the physician practice; rather, Blue Cross is looking to identify conditions/illnesses that demonstrate patients who are at ... August 7, 2014 Managed Care Anthem Blue Cross, Covered California, Health Insurance Exchange, Health Care Reform 0 0 Comment Read More »
