July 10, 2009 - CMS Publishes ICD-10-CM and ICD-10-PCS Information

The publication titled ICD-10-CM/PCS Myths & Facts (June 2009), which presents correct information in response to some myths regarding the ICD-10-Clinical Modification/Procedure Coding System, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network. Click here to view.

July 31, 2009 - Fraud and Abuse by Payers?

Uncontrolled greed is not just limited to patients and providers. Fraud and Abuse by payers is also alive and real. With the advent of Special Investigation Units (SIU) and Recovery Audit Contractors (RAC) that work on commissions with post payment audits, the door for abuse by payers has been opened. Because commission incentives bring the risks for payer abuse with intimidation and super aggressive tactics, a new problem has been created. Consequently, because of such risks, even CMS/Medicare has established an oversight agency to their RAC programs to checkmate such audit abuse. However, there is no such checkmate on the private industry.

Whereas payers are prone to engage in press releases with bragging about how much they have recovered from providers, not all of it can be justified as moral and/or legal. The only option to checkmate the non-Medicare insurance industry is legal action.

The ChiroCode Institute created a HOTLINE for all Providers. Their legal department is now collaborating with legal firms across the nation. You can be a part of the solution. Report any suspected fraud and abuse by insurance payers through our national Hotline (800-873-9877).

NOTE:  For non-chiropractic professions, we encourage you to contact the practice directorate of the professional association you belong to.

January 2009 - Medicare Expands Telehealth Services

Effective January 1, 2009, CMS now covers new telehealth (telemedicine) codes for inpatient consultations.  Read more here.

September 18, 2008 - HHS Proposes Adoption of ICD-10 Code Sets and Updated Electronic Transaction Standards

On September 18, 2008, the Department of Health and Human Services (HHS) made a long awaited announcement regarding ICD-10-CM.  On Friday, a proposed regulation was announced that would replace the ICD-9-CM code sets now used to report health care diagnoses and procedures with greatly expanded ICD-10 code sets, effective October 1, 2011.  In a separate proposed regulation, HHS has proposed adopting the updated X12 standard, Version 5010, and the National Council for Prescription Drug Programs standard, Version D.0, for electronic transactions, such as health care claims.  Version 5010 is essential to use of the ICD-10 codes.

Developed almost 30 years ago, ICD-9 is now widely viewed as outdated because of its limited ability to accommodate new procedures and diagnoses.  ICD-9 contains only 17,000 codes and is expected to start running out of available codes next year.  By contrast, the ICD-10 code sets contain more than 155,000 codes and accommodate a host of new diagnoses and procedures. The additional codes will help to enable the implementation of electronic health records because they will provide more detail in the electronic transactions.

Comments on the ICD-10 code sets proposed rule are due by 5:00pm Eastern time on October 21, 2008.

Comments on the updated transaction standards proposed are due by 5:00pm Eastern time on October 21, 2008.

Both regulations may be viewed at www.cms.hhs.gov/....

To read the HHS press release issued, please CLICK HERE.

FOr fact sheets describing both proposed rules please CLICK HERE.

September 2, 2008 - FindACode.com Officially Launches New Online Medical Coding Web Service

Find A Code, LLC launches www.FindACode.com today. FindACode.com is a revolutionary premium online service known as  "The Complete Online Coding Resource."  FindACode.com includes medical billing codes, descriptions,  plus ICD-9-CM, CPT (R), HCPCS, ABC documentation codesMedicare policies (LMRP, LCD, NCD), NCCI Edits, Fees, RVUs, alerts, and more.

"Find-A-Code is set to revolutionize the way medical coding professionals do their billing," said Dave Berky, CIO of FindACode, "By gathering together all the different data sources for code information into one simple website, we are providing an extremely efficient way of presenting all the coding information available. The coding experience is personalized according to your preferences. Plus any person can now access CPT(R) codes, HCPCS codes, ICD9-CM codes, Medicare policies (LMRP, LCD, NCD), NCCI Edits and RVUs with a simple search. If you can use Google (R), you can use our system!"

"Currently, so much of the coding data is locked into unusable or hard to decipher 'silos' of information," said John Clark, CTO of FindACode, "Find-A-Code has developed specific storage and searching technologies that allow us to merge, link and index all of these data sources into a single access point for our customers."

"Utilizing the power of the internet and flexibility of the web browser, Find-A-Code can present this specialized data in ways that transcend the 'book experience." It is more than just a legacy networked medical billing software package or PC-centric medical coding solution," said LaMont Leavitt, CEO of FindACode.

"It's amazing how I can just click around in Find-A-Code and go from one code to another. It's so simple to navigate and find the codes and information," said Peggy, a Utah coding specialist.

FindACode.com will be releasing new tools and data on a frequent basis. FindaCode.com already hosts thousands of visitors every month. The FindACode.com release date of Sept 2^nd, 2008 is in time for all of the new 2009 medical codes released in the fall of 2008.

Contact: LaMont Leavitt, CEO
http://www.findacode.com

August 25, 2008 - Medicare Payments Reduced IF You Owe IRS Taxes

The Taxpayer Relief Act of 1997, Section 1024, authorizes the IRS to reduce certain federal payments, including Medicare payments, to allow collection of overdue taxes. Should you owe such taxes and your payments are reduced, your remittance advice will reflect a provider level adjustment code (PLB) of “WU” in the PLB03-1 data field.  For more information, please see MLN Matters Article #MM6125 available at: 
www.instacode.com/downloads/MLN-MM6125.pdf

May 12, 2007 - New bill to require adoption of ICD-10

Once again, another bill has been introduced to replace ICD-9-CM with ICD-10-CM by 2011.

We support S.628 (introduced by Senator Norm Coleman).  ICD-9-CM has long needed to change to ICD-10-CM.

Contact your senator to encourage your support of this bill.
http://www.senate.gov/general/contact_information/senators_cfm.cfm

To read more about ICD-10, visit:  http://www.instacode.com/news-icd10cm-update.htm

May 12, 2007 - HHS Budget Proposal for 2008

The Department of Health and Human Services (HHS) has released details of the 2008 Fiscal Year budget.  The budget includes a comprehensive package of Medicare legislative and administrative proposals designed to strengthen the long-term financial security of the program.  Constraining Medicare spending is a key factor in meeting the President’s goal of slowing the growth in entitlement spending.
 
"Although exact fees have not been released, however, this sounds like there will continue to be fee decreases along with other proposed net savings through fraud crackdowns and other programs.

For more information about the budget, visit www.hhs.gov/budget/08budget/2008budgetinbrief.pdf

April 30, 2007 - Smoking Cessation Codes

Even though the smoking cessation codes are in the section of HCPCS for Medicare, they can be used to submit to other payors besides Medicare.  Each carrier can have their own policy coverage determinations.  It is a good idea to include a tobacco dependence ICD-9 code (305.1) and check with coverage through the payors provider relations department.

April 28, 2007 - Destroy patient data on computers before discarding

A recent article in ADVANCE for Health Information Professionals reminds all of us to take precautions when discarding old computers.  Please click the link below for a complete article.

In summary, we may forget that confidential patient information (PHI) may be contained on our computers. HIPAA security guidelines specifically state that we should follow reasonable procedures to protect that data.  Simply deleting files is not enough protection.  Those files are still stored on your computer and can be recovered unless specific procedures are performed.  Wiping, degausing, clearing and media destruction are the best methods to safe-guard your patient data.  All four methods are discussed in the article below.

April 28, 2007 - Recovery Audit Contracts and Your Practice

In May 2005, CMS began the recovery audit contract (RAC) in an effort to find Medicare underpayments and overpayments with a goal of collecting overpayments.  For now, RAC is only implemented in a few states, however, a national implementation is in the works.

There is some concern that discoveries made in the three states currently involved (California, New York and Florida) do not reflect coding practices in other states.  This would result in unfair "profiling" in other states.

This information comes from an article in the March 26, 2007 ADVANCE for Health Information Professionals magazine.  To read the entire article, see the link below.

At InstaCode Institute, we have always promoted correct coding practices.  The best thing you can do to safeguard your practice is to know and understand the codes you are using.  Make sure your patient documentation supports both medical necessity and the level of service billed to not only Medicare, but all payors.

April 24, 2007 - Medicare to reject UB-92 claims

Effective May 22, 2007, Medicare will reject all UB-92 claim forms.  You must begin using the new UB-04 claim form by this date.

You may download a copy of the Medicare MedLearn article from our website.  www.instacode.com/downloads/UB04_fact_sheet.pdf

The UB-92 claim for is for use with institutional claims only (NOT for individual professional services which need the 1500 form).  To order the UB-92 claim form, visit our online store:  Click here to go to the store.

April 24, 2007 - Medicare extends date for accepting old 1500 claim form (12-90)

Important Notice: Medicare Extends Date for Accepting Form CMS-1500 (12-90)

While Medicare began to accept the revised Form CMS-1500 (08-05) on January 1, 2007 and was positioned to completely cutover to the new form on April 1, 2007, it has recently come to our attention that there are incorrectly formatted versions of the revised form being sold by print vendors, specifically the Government Printing Office (GPO). After reviewing the situation, the GPO has determined that the source files they received from the NUCC’s authorized forms designer were improperly formatted. The error resulted in the sale of both printed forms and negatives which do not comply with the form specifications.   However, not all of the new forms are in error. 

Given the circumstances, CMS has decided to extend the acceptance period of the Form CMS-1500 (12-90) version beyond the original April 1, 2007 deadline while this situation is resolved. Medicare contractors will be directed to continue to accept the Form CMS-1500 (12-90) until notified by CMS to cease. At present, we are targeting June 1, 2007 as that date.In addition, during the interim contractors will be directed to return, not manually key, any Form CMS-1500 (08-05) forms received which are not printed to specification. By returning the incorrectly formatted claim forms back to providers, we are able to make them aware of the situation so they can begin communications with their form suppliers. The following will help to properly identify whether their version of the form needs to be updated. The old version of the form contains “Approved OMB-0938-0008 FORM CMS-1500 (12-90)” on the bottom of the form (typically on the lower right corner) signifying the version is the December 1990 version.

The revised version contains “Approved OMB-0938-0999 FORM CMS-1500 (08-05)” on the bottom of the form signifying the version is the August 2005 version. Checking the information at the upper right hand corner of the form is the best way to identify if that particular version is correct.  On properly formatted claim forms, there will be approximately a ¼ inch gap between the tip of the red arrow above the vertically stacked word “CARRIER” and the top edge of the paper. If the tip of the red arrow is touching or close to touching the top edge of the paper, then the form is not printed to specifications.

April 24, 2007 - CMS announces NPI (National Provider Identifier) contingency plan for small HEALTH PLANS ONLY

On April 3, 2007, the Centers for Medicare & Medicaid Services announced a contingency plan for covered entities (small health plans only) who will not meet the May 23, 2007 deadline for compliance with the NPI regulations.

Providers should be aware that such unique small health plans technically have until May 23, 2008 to meet the NPI deadline.  This means that although many payors are now requiring the use of the NPI, there are many payors who are not ready.  These payors are not in HIPAA violations.  Please be aware of which payors are ready and which are not. 

Recommendation:
1- Use both the new NPI and the old UPIN (legacy identifiers) on the 1500 claim for for the coming year.  Thus, small plans not yet using the new NPI will be able to incorporate it when they are ready.

2.- If you want to know exactly when they will commence using the new NPI, contact them directly to find out their requirements during this interim phase.

If you would like to read the contingency plan released by CMS, please CLICK HERE

October 31, 2006 - Medicare claims submission requires use of legacy numbers along with NPI

We have again received notification that Medicare providers will have until May 23, 2007, before they are required to submit claims with only an NPI. 

Because testing of the new CMS 1500 and the use of the NPI is still taking place, special considerations should be made when submitting claims.  According to Medicare, until further notice, continue to do the one of the following:

1.  Use your legacy number, such as your Provider Identification Number(PIN), NSC number, OSCAR number or UPIN; or
2.  Use both your NPI and your legacy number.

Medicare warns of claim delays or possible payment problems if claims are submitted with only the NPI at this time.

September 26, 2006 - If I receive an electronic remittance does that make me a HIPAA covered entity?

Q:  If a health care provider receives health information electronically (e.g. an electronic remittance advice), but does not transmit any health information electronically, is the health care provider a covered entity under HIPAA?

A:  No.  As long as you currently meet the criteria for a non-covered entity and you only receive information electronically, you do not automatically become a covered entity.

For more information on this question and others just like it, please click here.

April 19, 2006 - Medicare Part D Exceptions Request

A new standardized form for physicians to request an exception, and coverage for non-formulary drugs is now available.  The form can be downloaded from InstaCode Institute.

This new form was developed by America's Health Insurance Plans (AHIP) and the American Medical Association (AMA).  Many health insurance plans are expected to begin incorporating this new form immediately.

April 7, 2006 - Latest NPI information from Medicare

NPI Tip
When applying for your NPI, CMS urges you to include your legacy identifiers, not only for Medicare but for all payors.  If reporting a Medicaid number, include the associated State name.  This information is critical for payors in the development of crosswalks to aid in the transition to the NPI. 

Revised EFI Materials
The EFI Summary, User Manual and Technical Companion Guide have all been revised.  Please visit http://www.cms.hhs.gov/NationalProvIdentStand/07_efi.asp to view and download these revised materials.

Encore Presentation of WEDI’s NPI 101Audiocast
This presentation is scheduled for Thursday, April 27^th.  Please visit www.wedi.org for more information including scheduled times.

InstaCode Institute has more information on obtaining your NPI (National Provider Identifer) located on page F8 of the Behavioral Health MultiBook.  We also have a sample application available on our site at www.instacode.com/ftp/pub/NPI-application.pdf which can be downloaded free of charge.

For news articles related specifically to Mental Health (Behavioral Health) providers, see www.PsychCode.com/news

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