The 2009 Fall CSP Newsletter is available online. Please click here to view it. |
| California Society of Pathologists
One Capitol Mall Suite 320
Sacramento, CA 95814 Tel : 916-446-6001
Fax : 916-444-7462
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CSP Anthem Blue Cross Announces Major Reimbursement Reductions for Liquid Based Pap Smear Review
We have been contacted by several pathology groups that have noted substantial proposed reductions from Anthem Blue Cross in their PPO reimbursement of gynecologic cytopathology codes for manually screened and imaged liquid based preparations effective 1/1/10.
Specifically reimbursement to some providers for CPT 88142 (cytopathology, cervical or vaginal, collected in preservative fluid, automated thin layer preparation, manual screening under physician supervision) and 88175 (cytopathology, cervical or vaginal, collected in preservative fluid, automated thin layer preparation, with screening by automated system, and manual rescreening or review, under physician supervision) would be reduced to levels below Medicare and Medi-Cal. The specifics of reimbursement may vary based upon region or the provider.
The CSP asks your immediate cooperation for urgent data collection regarding cost per test for these two categories to provide an action initiative prior to implementation of Anthem's reimbursement reductions planned for January 1, 2010.
We intend to raise objections to Anthem Blue Cross regarding the magnitude of these cuts and the potential impact on access to this screening for their patients.
Data will be presented in aggregate form only and specifics from any individual group or lab will not be shared with any other member or entity. Please complete the form printed below for both 88142 and 88175 and return it to Bob Achermann at [email protected].
Click here to access a word document of the survey.
Click here if you prefer a .pdf of the survey.
Please fax or email it back to [email protected]. Your participation is greatly appreciated. |
Imporatant Advisory re: Medicare Part B Payments
Effective December 11, 2009, Palmetto GBA Jurisdiction 1 Medicare Administrative Contractor (MAC) will be transitioning our Part B financial accounting system from the Multi-Carrier System (MCS) to the Healthcare Integrated General Ledger Accounting System (HIGLAS). This transition involves only our financial accounting system. We will continue to use MCS for all of our claims processing activities.
Implementation of HIGLAS will enable the Centers for Medicare & Medicaid Services (CMS) to track Medicare payments and to accurately pay claims for over 40 million Medicare beneficiaries. The transition will also provide CMS with enhanced oversight of contractors' accounting systems and access to more accurate, timely and consistent data for decision-making and for performance evaluations.
A HIGLAS education letter containing the following information from Palmetto GBA was mailed to all J1 Part B providers in November, 2009.
Introduction to HIGLAS
Updated information regarding our HIGLAS implementation is available from the HIGLAS link in the Self Service Tools and Top Links section on the Palmetto GBA J1 Part B home page. This same information will be issued in our e-mail update and published in our monthly advisory.
Temporary Waiver of the Claims Processing Payment Floor
CMS has approved Palmetto GBA's waiver request to reduce the payment floor for both paper and Electronic Data Interchange (EDI) claims. Beginning December 9, 2009, the payment floor will be reduced to zero for both EDI and paper claims, and payments will be released for claims that have already been approved for payment.
This temporary reduction of the payment floor will result in payments being issued early (checks and Electronic Funds Transfers (EFTs)). This may give the appearance that your cash revenues have increased when in fact payments for some of your claims may have simply been made earlier than normal. Providers are encouraged to monitor their payments and make adjustments as necessary to prevent cash flow problems during the transition period.
HIGLAS Transition Activities
On December 9, 2009, Palmetto GBA J1B will run our last MCS payment cycle and begin the HIGLAS transition (See Palmetto GBA J1B HIGLAS transition timeline below). Waiver of the payment floor will result in claim payments (checks and EFTs) being issued earlier than normal. Online systems will go down at 10 p.m. EST.
- Providers are encouraged to continue submitting claims as normal
- Following our transition to HIGLAS, Palmetto GBA J1 Part B will resume normal scheduled payments
HIGLAS Payments and Remittance Advices
Palmetto GBA J1B will not be issuing payments from December 10 through December 15, 2009. Electronic Remittance Advices (ERAs) and paper RAs will not be available. Palmetto GBA J1B will resume normal payment cycles and issuance of payments on December 16, 2009, at which time providers will be able to retrieve their ERAs.
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