Monday, November 16th, 2009
Highmark Medicare Services recently announced that Medicare Physician Fee Schedule (MPFS) amounts are currently unavailable on its Web site because the Center for Medicare and Medicaid Services (CMS) is expected to issue a correction.
Monday, November 16th, 2009
To ensure proper reimbursement, billing staff will need to update their standard knowledge of Advance Beneficiary Notice (ABN) modifiers. A Medicare policy revision due to take effect in 2010 changes modifier usage when reporting certain types of liability notices for non-covered services to a Medicare payer. Read more »
Friday, November 13th, 2009
End-stage renal disease (ESRD) facilities concerned about a proposed ESRD prospective payment system (PPS) that would replace the current payment system and methodologies still have time to stand up and be heard. The Centers for Medicare & Medicaid Services (CMS) has extended the comment period out by 30 days.
Confused about the Evaluation and Management Consultation codes in CPT® 2010 (99241-99255)? Didn’t Medicare just say that, save for HCPCS Level II codes for telehealth consultation, they were out the window? (See “2010 MPFS Final Rule Still Holds Surprises,” EdgeBlast No. 136.) So why are they in the official CPT® code book? Is it a mistake, and if not, does that mean commercial payers are reimbursing for them?
It’s no mistake, says Sheri Bernard, CPC, CPC-H, CPC-P, vice president, clinical coding communications, AAPC. “The codes remain in CPT® 2010 with expanded official guidelines that identify scenarios that in the past would not have been considered consultations,” according to Bernard.
Check with payers to whom you report these codes to find out if they are reimbursing them and for what services specifically. Unfortunately, at this point no one really knows what all the payers will think of these codes now.
AAPC former NAB member Barbara Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, is asking colleagues to contact her with what payers in their states say they will accept come Jan. 1, 2010. She will compile the data into a spreadsheet and make it available via the AAPC Web site.
If you’d like to contribute information to this project, and help Cobuzzi clear the confusion with her grass-roots project, send what you’ve learned about payers in your area to her in an e-mail (b.cobuzzi@att.net).
National Heritage Insurance Company (NHIC) issued a notification update Oct. 14 to clarify its coding and utilization guidelines for certain male external catheters supplied to Medicare beneficiaries.
Monday, November 2nd, 2009
The U.S. Food and Drug Administration (FDA) announced Oct. 23, in response to a request from the U.S. Centers for Disease Control and Prevention (CDC), it has issued an emergency use authorization (EUA) for the investigational antiviral drug peramivir intravenous (IV) in certain adult and pediatric patients with confirmed or suspected 2009 H1N1 influenza infection who are admitted to a hospital.
Monday, November 2nd, 2009
The Centers for Medicare & Medicaid Services (CMS) began accepting bids for the Round One Rebid of the Medicare Competitive Bidding Program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) on Oct. 21. Qualified DME suppliers in nine areas have until Dec. 21 to submit bids.
Registration to participate in the Round One Rebid is nearing an end. Suppliers that wish to submit bids must be registered by Nov. 4, 9 p.m. EST.
Monday, November 2nd, 2009
The annual update to the clotting factor furnishing fee is $0.170 per I.U. and is effective from Jan. 1, 2010 to Dec. 31, 2010. This fee is included in the published payment limit for HCPCS Level II clotting factor billing codes (J7189-J7195) and added to the payment for a clotting factor when no payment limit is published either on the Average Sales Price (ASP) Medicare Part B Drug Pricing File or the Not Otherwise Classified (NOC) Pricing File.
Monday, November 2nd, 2009
The 2010 payment limits for splints and casts will be based on 2009 payment limits. Due to a -1.41 percent change in the consumer price index for all urban consumers (CPI-U) for the 12-month period ending June 2009, the inflation indexed charge (IIC) update factor for 2010 is 0 percent. Read more »
Wednesday, October 21st, 2009
Long-discussed reconsideration of F-18 fluoro-D-glucose (FDG) positron emission tomography (PET) scanning of solid tumors and myelomas has been completed by the Centers for the Medicare & Medicaid Services (CMS). The changes, to be implemented Oct. 30 and retroactively effective to April 3, are extensive.
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