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Institutional Claim UB04 Update | |
National Uniform Billing Committee (NUBC)
Effective: December 12, 2012
Revenue Code 0524 - Clarification. The revenue code does include skilled swing beds: "Visit by RHC/FQHC Practitioner to a Member in a SNF or Skilled Swing Bed in a Covered Part A Stay.
Discharge Hour - Discharge Hour is required on all final inpatient claims, except for 021x. This includes claims with a Frequency Code of 1 (Admit through Discharge), 4 (Interim-Last Claim) and 7 (Replacement of Prior Claim) when the replacement is for a prior final claim.
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Payer Update
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United Healthcare
How to submit electronic claims with unlisted service or procedure codes. Some services or procedures performed by physicians or other health care professional may not have specific CPT or HCPCs codes assigned. We want you to know that claims with unlisted service or procedure codes can be submitted electronically to United Healthcare.
January Network Bulletin
Aetna
Large scale internal testing of ICD-10 will start during the first half of 2103. This will be followed by targeted external testing later that year. Testing will continue into 2014.
January Bulletin by Region
Mid America
Southeast
West
Cigna
Precertification changes: On January 1, 2013, the AMA and CMS released new CPT and HCPCs codes. Codes released as a part of their updates will be reflected on our Precertification list this month.
On February 18, 2013, we will update our list of existing CPT and HCPCs codes to include 47 additional codes that will require Precertification. At that time, we will also remove 56 codes from the Precertification list. Detailed listing code changes in bulletin.
Network Bulletin
Tricare
The Uniform Business Office has released a Fall 2012 Newsletter. |
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Medicare Quarterly News
Changes to Contractor Designation in Processing Foreign, Emergency and Shipboard Claims
Effective: January 29, 2013
All contractors are designated to process claims for physicians' and ambulance services furnished in connection with a covered hospital stay in Canada and Mexico for their beneficiaries who reside in the states/areas for which they process claims.
Transmittal 2625 CR8103
Implementing the Claims-based data collection requirement for OP Therapy Services
Effective: January 1, 2013
Application of new coding requirements. This functional data reporting and collection system is effective for therapy services with dates of service on and after January 1, 2013. However a testing period will be in effect from January 1, 2013, through June 30, 2013, to allow providers to use the new coding requirements in order to assure that their systems work. During this time period claims without G-codes and modifiers will be processed.
Transmittal 2622 CR8005
MLN Matters MM8005 Revised
NEW FISS consistency edits to validate attending physician NPI
Effective: January 1, 2013
Implementation: January 7, 2013
Shall install a consistency edit for institutional claims to ensure that the institutional provider has not used their billing NPI in the Attending Provider NPI Data Element. Institutional billing of influenza and pneumococcal vaccinations and their administration as the only billed service on a claim or roster billing of these vaccinations and their administrations are exceptions to this process.
Transmittal 2560 CR7902
MLN Matters MM7902 | |
Implementation of Changes to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) consolidated billing requirements for Daptomycin and a clarification of outlier services for calendar year 2013
Effective: January 1, 2013
Implementation: January 7, 2013
Peginesatide is a new Erythropoiesis-Stimulating Agent (ESA) drug approved for the treatment of anemia in dialysis patients. Peginesatide has been assigned a permanent HCPCs code of J0890. Claims containing J0890 more than once per billing cycle will be returned to the provider.
Transmittal R2588CP CR7869
MLN Matters MM7869
MLN Matters MM8050
Update of the Hospital OPPS
Effective date: January 1, 2013
Implementation date: January 7, 2013
The AMA's CPT Editorial Panel is deleting CPT codes 92980 and 92891 and replacing with the following codes: 92928, 92929, 92933, 92934, 92937, 92938, 92941 & 92943.
MLN Matters MM8141
Integrated Outpatient Code Editor (I/OCE) specifications version 14.0
Effective date: January 1, 2013
Implementation date: January 7, 2013
Add new modifiers CH, CI, CJ, CK, CL, CM and CN (% impaired, limited or restricted); LM and RI to the valid modifier list.
MLN Matters MM8137
Update to Publication 100-04, Claims processing instructions for Chapter 12, Non-Physician Practitioners (NPPs)
Effective date: February 19, 2013
Implementation date: February 19, 2013
PAs must have their own 'non-physician practitioner' national provide identification (NPI) number. This NPI is used for identification purposes only when billing for PA services, because on an appropriate PA employer or a provider/supplier for who the PA furnished services as an independent contractor can bill for PA services.
CMS adds the following CPT codes should to the List of Telehealth Services of G0396, G0397, G0442, G0443, G0444, G0445 and G0446.
New informational unsolicited response (IUR) process to identify previously paid claims for services furnished to incarcerated Medicare beneficiaries
Effective date: April 1, 2013
Medicare will generally not pay for medical items and services furnished to a beneficiary who was incarcerated on the date of service the items and services were furnished.
New Place of Service (POS) code for place of employment/worksite. Revised and Clarified POS coding instructions
Effective: April 1, 2013
Updates the current Medicare POS code set to add a new code: 18 - Place of Employment/Worksite; described as: 'all locations, not described by another POS code, owned or operated by a public or private entity where the patient is employed, and where a health professional provides on-going or episodic occupational medical, therapeutic, or rehabilitative services to the individual."
Transmittal 2613 CR7631 |
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Medicare Fee-For-Service Recovery Audit Program Myths
Myth: RAC's have a contingency fee between 30 and 50 percent.
Myth: Every RAC denial is overturned on appeal.
Myth: RAC have non-clinicians conduct review of medical records.
Myth: RAC create their own policies and are not bound by CMS regulations, NCDs, or LCDs.
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CMS response here
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 What sets Cirius Prebill apart from other claim scrubbers?
- We deliver clean claims DIRECTLY to the payer. We are NOT a clearinghouse.
- Center of Edit Excellence delivering timely compliant vendor maintained all payer standard error edits as well as automatic corrective edits.
 Jayne Kroner, Editor
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Physician Articles
AMA releases Practice Management Center Book called "Follow that Claim" claim submission, processing, adjudication and payment guidelines.
Preventive Immunizations Instructions and Overview
Details here
Complying with Medicare Signature Requirements
Details here |
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 | 1500 Health Insurance Claim Form
Version 8.0
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On the Horizon
ICD10
How Claims are Affected by ICD-10 Translation
26% Claims with translations that do not affect DRG
18% Claims with Dx codes with 1-many translations that affects DRG
14% Claims with proc codes with 1-many translations that affects DRG
42% Claims with both Dx and proc codes with 1-many translations that affects DRG
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A white paper by WEDI given details.
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Compliance Corner
Medicare Quarterly Provider Compliance Newsletter
Volume 3, Issue 2
January 2013 | |
Guidance to Address Billing Errors
Page 1 - Hospice Related Services - Part B
Page 4 - Syncope and Collapse
Page 6 - Inpatient Hospitals RAC Finding: Other Operative Room Procedures for Injuries
Detailed Report
Hospital-Acquired Conditions (HAC) in Acute IPPS Hospitals
Detailed Codes |
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Navigating 5010
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CMS Announces 90-Day Period of Enforcement Discretion for Compliance with Eligibility and Claims Status Operating Rules
"will not initiate enforcement actions until March 31, 2013, with respect to HIPAA covered entities" Announcement here
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Healthgrades Hospital Excellence Report 2013
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All hospitals are not created equal: Hospital Choice Matters
Full Report here
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