Noridian denies 300,000 claims for E&M services in error Last fall, the Centers for Medicare and Medicaid Services experienced some editing issues with new patient evaluation and management (E&M) codes that resulted in incorrect claim denials. These issues began in October 2013, and were thought to have been corrected in late January 2014. The California Medical Association recently learned, however, that some claims continued to be denied incorrectly through July 15, 2014. In January, Noridian, California's Medicare contractor, began reprocessing claims that had been denied in error and correcting those subjected to overpayment recovery. Unfortunately, while implementing the corrections, ... September 4, 2014 Medi-Cal, Medicare Medicare, Noridian, Billing/Coding 0 0 Comment Read More »
Huge chunk of data excluded from Open Payments website because of inaccuracies According to several news sources, the Centers for Medicare & Medicaid Services (CMS) has rejected about one-third of the "Open Payment" records submitted by manufacturers and group purchasing organizations (GPOs) because of "intermingled data." When the data goes public next month, those records will not be included. CMS says it will not publish the withheld data until June 2015, when it expects that manufacturers will have had time to correct the inaccuracies. Physician Payments Sunshine Act is a provision of the Patient Protection and Affordable Care Act. Drug and medical ... August 21, 2014 Medi-Cal, Medicare CMS, Physician Payment Sunshine Act, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
State audit finds DHCS may have paid $93.7 million for fraudulent Medi-Cal drug treatment A California State Auditor’s report issued today found the Department of Health Care Services (DHCS) failed to properly administer the Medi-Cal Drug Treatment Program and may have paid at least $93.7 million for fraudulent drug treatment. The program provides substance abuse services to Medi-Cal beneficiaries when physicians determine they are medically necessary. The focus of the report was on outpatient drug-free services. The audit was requested by Assemblyman Ted Lieu after stories appeared in the media revealing that substance abuse clinics were fraudulently billing for patients who did not use ... August 21, 2014 Medi-Cal DHCS, Drug Abuse, Medi-Cal, Insurance/Reimbursement 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 »
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 »
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 »
CMS issues proposed 2015 Medicare payment rule The Centers for Medicare and Medicaid Services (CMS) recently published the 2015 proposed Medicare physician payment rule in the Federal Register. The proposal contains several notable changes. The rule expands the services eligible for telemedicine reimbursement (psychotherapy services and the annual wellness visit). It also extends the new payment policies for non-face-to-face care coordination. It allows primary care physicians to be paid for care management of Medicare beneficiaries with two or more chronic conditions. These are tasks (including managing lab and imaging reports, medications and care plans in addition ... August 4, 2014 Medi-Cal, Medicare Insurance/Reimbursement, Medicare, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
California among six states that pay the least for Medicaid beneficiaries, says GAO report According to a report released this week by the U.S. Government Accountability Office (GAO), California is one of six states that spends less than $6,000 per Medicaid (Medi-Cal in California) enrollee per year. The other states include Illinois Alabama, Arkansas, Mississippi and Tennessee. In contrast the report found that eight states, including New York, spend at least $10,500 per beneficiary. The report also found that Medi-Cal fee-for-service pays on average 61 percent of what private insurers in the state pay for the same evaluation and management services, with Medi-Cal ... July 22, 2014 Medi-Cal Insurance/Reimbursement, Medicaid, Access to Care, Medi-Cal 0 0 Comment Read More »
California budget does not restore 10 percent cut to Medi-Cal providers California lawmakers approved a $156.4 billion state budget plan yesterday that does not restore a 10 percent cut to Medi-Cal for providers – meaning that California continues to balance its budget on the backs of California's neediest and most vulnerable patients. Thanks to California Medical Association (CMA) advocacy, in coordination with the "We Care for California" coalition, the budget does, eliminate retroactive collection of the 10 percent Medi-Cal cut that would have dated back to June 2011, saving Medi-Cal providers more than $42.1 million in retroactive "clawbacks." “Eliminating the retroactive collection ... June 19, 2014 Medi-Cal Medi-Cal, State Legislative Advocacy, California State Budget 0 0 Comment Read More »
