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Professional Claim 1500 Update
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National Uniform Claim Committee (NUCC)
March 27, 2012
Announces the release of a revised version of the 1500 Health Insurance Claim Form (version 02/12). This revised version will update the current 1500 Claim From (version 08/05), often referred to as the "HCFA 1500 or CMS 1500."
Announcement here
Most Notable Change: addition of 8 additional lines for diagnosis codes.
Timeline:
June 1, 2013-Health Plans, clearinghouses and other information support vendors are ready to handle and accept the revised (02/12) 1500 Claim Form.
June 1-September 30, 2013-Providers may use either format. All others must support both versions.
October 1, 2013-Current form (08/05) is discontinued: only the revised form (02/12) accepted which will include rebilled claims with services dates prior October 1, 2012.
1500 Revised Form 1500 Change Log 02/17/12 |
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Payer Update
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United Healthcare
This 2012 Physician, Healthcare Professional, Facility and Ancillary Provider Administrative Guide applies to covered services you provide to customers under a benefit plan insured by or receiving administrative services from United Healthcare and its affiliated, unless otherwise noted.
All items within this Guide that describe how you must do business with us are Protocols under the terms of your agreement.
Advanced Notification: Beginning April 1, 2012, for those services on the Advance Notification List, facilities are required to confirm, prior to rendering the service(s) that coverage approval is on file.
UHC may deny the facilities claim for the non-covered service and the member must be held harmless.
If coverage is approval is on file, we will not deny the facility's claims despite the facility's failure to take special action to confirm the coverage approval.
Admission Notification: Beginning April 1, 2012, if timely admission notification is not provided, reimbursement reductions will apply as described in the 2012 UHC Administrative Guide.
2012 Administrative Guide
Network Bulletin
Medicare Section 1011--News Alert!
Name Change from Highmark to Novitas Solutions
Q: Do I need to inform my vendor, clearinghouse or billing service of this name change?
Yes. They may have written a script that you invoke when you submit payment requests or retrieve reports. Changes to the script may be needed due to this name change.
All FAQ's here
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Medicare Quarterly News
Screening for Depression in Adults
Effective: October 14, 2011
Implementation: April 2, 2012
For claims processed on or after April 2, 2012, Medicare will allow payment for G-444 no more than once in a 12 month period. Medicare will allow both a claim for the professional service and for the facility fee. As of July 2, 2012, provider inquiry screens will display a next eligibility date.
MLN Matters MM7637Update to Pub 100-04, "Medicare Claims Processing Manual," Chapter 3: Inpatient Hospital Billing
Effective: April 22, 2012
A new example has been added to show how to utilize Occurrence Span Code 70 when the beneficiary only had Life Time Reserve days remaining and they are exhausted during the stay.
MLN Matters MM7706
CMS Transmittal 2388 CR7706
| Outpatient Code Editor Specifications, Version 13.1
Effective & Implementation Date: April 2, 2012
Key Points:
Delete modifiers V8 & V9 from the list of valid modifiers. New service approved for Fluorescent Vascular Angiography using HCPC code C9733.
And much more......
Provider Inquiry Screens Regarding Telehealth Services Eligibility Date
Telehealth services have frequency limitations. When providers submit inquiries to Medicare the system responds with provider inquiry screens. These screens will now provide the date on which the beneficiary is next eligible for these frequency limited services.
The role of the Zone Program Integrity Contractors (ZPICs). Medicare contractors listed here for all ZPIC zones. Primary goal of ZPICs is to investigate instances of suspected fraud, waste, and abuse. They also identify improper payments that are to be recouped by the MAC.
MLN Matters SE1204
Clarification of Patient Discharge Status Codes and Hospital Transfer Policies-Revised
The IPPS Post-Acute Care Transfer Policy applies to claims coded with patient discharge status codes 03,05,06,62,63 and 65.
MLN Matters SE0801
Global Surgery
In addition to the global policy, uniform payment policies and claims processing requirements have been established for other surgical issues, including bilateral and multiple surgeries, co-surgeons and team surgeries. The information describes the components of a global surgical package and billing payment rules for surgeries, endocrine, and global surgical packages.
FACT SHEET
Telehealth Services
Publication provides the following information about services furnished to eligible Medicare beneficiaries via a telecommunications system. Origination dates; distant site practitioners; Telehealth services and HCPCs codes; billing and payment for professional services furnished via Telehealth; billing and payment for the originating site facility fee and resources.
Medicare Claim Submission GuidelinesThis publication offers providers and suppliers the following information: Applying for a NPI and enrolling in Medicare program; filing Medicare claims; private contracts with Medicare beneficiaries; and resources.
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Claims hung out to dry with RAC audits?
Beginning March 15, 2012
CMS Additional Documentation Limits for Medicare providers:
- Maximum request is per campus.
- Each limit is based on the provider's prior calendar year Medicare claims volume.
- Maximum number of requests per 45 days is 400.
- Auditors may request up to 35 records per 45 days from providers whose calculated limit is 34 ADR's or less.
- Limit is equal to 2% of all claims submitted for the previous calendar year divided by 8, an increase from the previous 1% limit.
- For SNF claims, one ADR represents a beneficiary's entire episode of care.
CMS may give the RAC permission to exceed the limit.
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Detailed report here
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Contact us today, as Cirius is built on integrity and thrives on industry challenges. We will respond to any type of customer request within 48 business hours. Contact us at: revenue@ciriusgroup.com or 925.685.9300.
Regards, Jayne Kroner, Editor
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 | World Health Day
April 7, 2012
This video was developed by WHO for 2012 message.
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 | Hospital Readmissions
The healthcare reform law requires CMS to implement the 'hospital readmissions reduction program' for discharges on or after October 1, 2012. It will begin examining three diagnoses, acute myocardial infarction, heart failure and pneumonia with respect to readmissions with 30 days.
Review Section 40.2.5Billing Guidelines here |
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Navigating 5010
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CMS 5010 Update Claims Processing Rejections-Claims with certain DRGs are rejecting inappropriately. If a provider's claims fail for the DRG code being invalid, the provider needs to remove the DRG from the claim...National
Transaction Levels CMS Volume Percentages Part A Claims at 75.3%
Part A Submitters 54.7%
Part B Claims 92.4%
Part B Submitters 56.3%
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On the Horizon
ICD10
Providers Survey:
When do you plan to start the ICD10 impact assessment? Replies:
Late 2011=15%
2012=10%
Unknown=15%
Started=35%
Completed=25%
Compare your facility with others across the nation.
Full survey here
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Compliance Corner
| Hospitals must furnish ambulance services to inpatients directly or by arrangement with ambulance providers, unless transport occurred on day of admission, discharge or leave of absence noted with occurrence span code 74 for the dates indicated plus one day.
Plus many other Medicare Billing Tips!
Full report here Medicare Claim Review Programs: MR, NCCI Edits, MUEs, CERT and Recovery Audit Program Instructional brochure here |
Department of Health and Human Services require Insurers to Use Plain Language in Describing Health Plan Benefits and Coverage
The new explanations will be available beginning or soon after September 23, 2012.
Medicare redesigns claims and benefits statement The redesigned statement known as the Medicare Summary Notice (MSN) will be available online and starting in 2013 mailed out quarterly to beneficiaries. Side by Side Comparison |
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