Archive for the ‘Industry News’ Category

The U.S. Food and Drug Administration (FDA) has approved the use of CSL Limited’s 2009 H1N1 influenza vaccine to include children ages 6 months and older. The vaccine was previously approved only for use in adults, ages 18 years and older. The expanded approval also covers the Australian company’s seasonal flu vaccine.

The vaccines will be available in single-dose, preservative-free, pre-filled syringes, and multi-dose vials.

The U.S. Food and Drug Administration (FDA) and Edwards Lifesciences notified health care professionals, Nov. 9, about the Class 1 recall of CardioVations EndoClamp™ Aortic Catheter, model numbers EC1001 and EC65. The recall was initiated because the balloon catheters may spontaneously rupture during surgery.

This product was manufactured from August 2008 through August 2009 and distributed from November 2008 through September 2009.

The device blocks off the aorta, monitors aortic pressure, and delivers solution to stop the heart during cardiopulmonary bypass procedures.

On Oct. 29, 2009, the manufacturer sent a follow-up letter to their customers instructing them to:

• Check their inventory and identify any unused product; and 
• Return unused products to the company.

Class 1 recalls are the most serious type of recall and involve situations in which there is a reasonable probability that use of the product will cause serious adverse health consequences or death.

Health care professionals and consumers may report adverse reactions or quality problems experienced with the use of this product to the FDA’s MedWatch Adverse Event Reporting program.

A recent RAND Corporation study provides another incentive for physicians to implement electronic health care records (EHRs) — in addition to that really good one that mandates EHR meaningful use by 2014. According to the study, dedicated EHR use improves quality of care for patients and facilitates quality reporting for physicians. This, in turn, ensures eligible professionals (EPs) receive the full Physician Quality Reporting Initiative (PQRI) incentive. An Ingenix survey, however, says many physicians remain skeptical that the benefits would outweigh the cost of implementing an EHR system. Read more »

At a time when Medicare is saying no to consultation codes, a Northeast insurer is saying yes to reimbursement claims from network physicians for Web-based consultations. Read more »

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.

Read more »

Google has launched a live online map service that will help your patients find flu shots, both seasonal and H1N1.

The Internet company built the flu shot finder in collaboration with the Department of Health and Human Service (HHS). The service allows users to search within a specified area and locate providers — mostly chain pharmacies — where immunizations are available.

Because of its newness, it may not have all the sites yet, but it will provide consumers with sources for immunizations.

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 »

Medicare rural health centers (RHCs) and federally qualified health centers (FQHCs) can expect to see payment updates in 2010 thanks to an increase in the Medicare Economic Index (MEI), according to the Centers for Medicare & Medicaid Services (CMS). Read more »

The Centers for Medicare & Medicaid Services (CMS) has made a few important changes to the National Coverage Determination (NCD) edit software for clinical diagnostic laboratory services worth noting. In particular, a change to the effective date of coverage for three NCD ICD-9-CM diagnosis code lists will allow clinics to recoup any lost payments due to erroneous denials.

The effective date for three NCDs was “inadvertently” changed from Oct. 1, 2007 to July 1, 2009 with the July 1 quarterly release. The January 2010 quarterly release of the edit module for clinical diagnostic laboratory services corrects this mistake.

The affected ICD-9 code lists are those in the following NCDs:

• Prothrombin Time (PT) (190.17)
• Serum Iron Studies (190.18)
• Gamma Glutamyl Transferase (190.32)

The effective date for the ICD-9 codes listed in these NCDs will be revised from July 1, 2009 to Oct. 1, 2007, effective Jan. 1, 2010.

The January 2010 quarterly update also relocates ICD-9 codes 453-50 – 453.52 from the Serum Iron Studies NCD to the Gamma Glutamyl Transferase NCD, effective Jan. 1, 2010.

Medicare instructs contractors in Transmittal 1847, issued Nov. 6, not to search their files to retroactively pay claims but to adjust claims brought to their attention. A provider education article is available on the CMS Web site, and includes a list of affected ICD-9 codes.

National Government Services (NGS) says Error Code (EC) 31 Services incorrectly coded denials have been increasing in relation to CPT® 85025 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count.

“Review of the CERT data shows that the CERT contractor has been re-coding CPT 85025 to show the appropriate service rendered,” NGS writes in its November 2009 Medicare Monthly Review (MMR). So how should billing staff code this service?

NGS says, generally, CPT® 85027 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) is more appropriate.

Correct coding: If the physician has ordered only a CBC (with no mention of a differential), the correct code is 85027.

To prevent EC 31 denials, providers should review the medical records and the physician order/requisition before performing and coding the service to make sure what is being done and billed matches the order.