Recovery Audit Contractors (RAC) HealthDataInsights (HDI) and CGI Federal have added to their list of new issues eligible for review as per the Centers for Medicare & Medicaid Services (CMS).

The RAC program, mandated by the Tax Relief and Health Care Act of 2006, is being implemented in 2010 to detect and correct past improper Medicare payments.

Tip: Don’t wait until Jan. 1, 2010 to review these new issues and correct any problems your outpatient hospital or physician practice may uncover. Read more »

Want to increase the number of claims that successfully complete processing and enhance a positive cash flow? Heed Noridian Administrative Services’ (NAS) advice. The Medicare administrative contractor (B/MAC) has identified its top five denials for the months of July, August, and September and offers solutions and resources. Read more »

Hospitals who successfully participated in quality data reporting for outpatient services will receive a 2.1 percent inflation update in their 2010 payment rates for services furnished to Medicare beneficiaries in outpatient departments, according to the Centers for Medicare & Medicaid Services (CMS). Ambulatory surgical centers (ASCs) will receive a 1.2 percent inflation update beginning Jan. 1, 2010 using the same payment methodology as in 2009.

These and other payment and policy changes can be found in the 2010 Hospital Outpatient Prospective Payment System (OPPS) and ASC final rule with comment period — put on display for review Oct. 30.

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Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) added new mandatory reporting requirements for group health plans (GHP) and non-group health plans (NGHP), such as liability insurance (including self-insurance), no-fault insurance, and workers’ compensation.

The implementation dates for most casualty insurers have come and gone, but there’s still time for compliance.

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The Centers for Medicare & Medicaid Services (CMS) updated, Oct. 14, its Medicare Fee-for-Service (FFS) Q&As to address H1N1-related questions circling among the health care industry. Read more »

The Centers for Medicare & Medicaid Services (CMS) announced, Oct. 30, final changes to 2010 Medicare Physician Fee Schedule (MPFS) policies and payment rates. Taking into account all changes in the final rule, CMS projects a payment increase between 5 and 8 percent for health care professionals paid under the MPFS. That’s the good news …

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An Oct. 8 post on TrailBlazer Health Enterprises’ Web site notifies Parts A and B providers that HCPCS Level II code J3420 is no longer covered as a self-administered drug, as indicated on the Self-Administered Drug Exclusions list, effective for service dates on or after Oct. 12.

Changes the Centers for Medicare & Medicaid Services (CMS) recently made to the Medicare Claims Processing Internet Only Manual may affect the way providers and suppliers report claims for multi-passenger ambulance services in the near future.

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Carriers and Part A and Part B Medicare Administrative Contractors (A/B MACs) are creating lists and checking them twice, but they’re not looking for who’s been naughty or nice. On these lists are X-ray suppliers currently billing Medicare who are not in the Provider Enrollment, Chain, and Ownership System (PECOS). Read more »

Physicians, non-physician practioners (NPPs), and other Part B providers and suppliers submitting claims to carriers or Part B Medicare Administrative Contractors (B/MACs) for ordered or referred items or services can expect further scrutiny during the claims editing process.

Beginning Oct. 5, carriers and B/MACs expanded claims editing to include validation of the ordering/referring provider’s national provider identifier (NPI) and name reported on the claim against Medicare’s provider enrollment records. Read more »