Accurate coding and reporting of services are critical aspects of proper billing. The Medicare National Correct Coding Initiative was implemented to promote national correct coding methodologies…
Category Archives: medicare coding
Medicare for Eye-care: Coding and Billing Guidelines: Audio Educator
Click here for more Information: http://www.audioeducator.com/ophthalmology/medicare-eye-care-coding-biling-09-10-2014.html Medicare for Eye-care: Coding and Billing Guidelines Presented By:…
HHS Report Finds Medicare Advantage Plans Exaggerate Members …
Many Medicare Advantage health plans routinely overbill the government for treating elderly patients — and have done it for years, a federal study shows.
Department of Health and Human Services researchers found that many plans exaggerate how sick their patients are and how much they cost to treat. Medicare expects to pay the privately run plans — an alternative to traditional Medicare —$160 billion this year.
The HHS study does not accuse any specific insurers of wrongdoing or name the plans that were scrutinized. But the researchers offer the most comprehensive evidence to date that suspect billing practices have been common across much of the Medicare Advantage industry and are likely to get worse unless officials crack down.
“Further policy changes will likely be necessary,” the study concludes.
Congress created Medicare Advantage in 2003 to encourage private insurance companies to venture into the senior care market. The plans now insure 16 million elderly and disabled people, nearly a third of those eligible for Medicare. They are popular with seniors because they often provide extra benefits, such as eyeglasses and dental care, and can cost less out-of-pocket than standard Medicare.
Medicare pays the Advantage health plans higher rates for sicker patients and less for healthy people using a complex formula called a “risk score.” But the HHS study spells out several ways health plans have inflated those scores, from reporting surprisingly high levels of medical conditions such as alcohol or drug dependence to billing for an inordinately high number of patients with complications of diabetes.
Despite its broad implications for Medicare spending, the study by HHS researchers Richard Kronick and W. Pete Welch has attracted scant notice in Washington. It was quietly posted late last month on an online research site run by the Centers for Medicare & Medicaid Services, part of HHS.
Kronick directs the HHS Agency for Healthcare Research and Quality, whose mission is to improve health care delivery. Welch works for the HHS Office of the Assistant Secretary for Planning and Evaluation. The authors note that the study does not necessarily reflect HHS views, but both offices are influential in advising the government on policy matters.
CMS officials declined comment.
“This is clearly impacting what taxpayers are paying for Medicare Advantage, I think, not in a good way,” said Dr. David Wennberg, a researcher at the Dartmouth Institute for Health Policy and Clinical Practice who has studied Medicare billing trends.
Health care fraud expert Malcolm Sparrow, a professor at Harvard’s Kennedy School of Government, said the problems with billings based on risk scores reveal how “financial incentives” can improperly influence how medicine is practiced.
“The problem seems significant,” he said.
The new study amplifies the findings of a Center for Public Integrity investigation published in June. The investigation found that Medicare made nearly $70 billion in “improper” payments — mostly overcharges from inflated risk scores — to Medicare Advantage plans from 2008 through 2013. The center’s investigation also found that risk scores rose much faster in some health plans than others and that federal officials repeatedly yielded to industry pressure to minimize efforts to recoup overpayments.
Medicare Advantage plans are paid a set monthly fee for each patient based on the risk scores, and the government largely trusts the health plans to report the health status of people they enroll. About 70 medical conditions can boost payment rates.
Clare Krusing, a spokeswoman for America’s Health Insurance Plans, the industry’s trade group, said the higher billing resulted from health plans working with patients “to understand their specific health conditions, and consequently make sure they get the care they need.”
“What was not highlighted (in the study) is the fact that these programs have demonstrated improved quality in patients’ health,” she wrote in an email.
However, the study concludes that people who join Medicare Advantage plans are healthier than those who remain on standard Medicare, which pays doctors and hospitals for each service they provide. The study also says it’s “unlikely” the higher payments health plans derive from diagnosing more medical conditions “are related to substantial health benefits.”
In short, the numbers of patients diagnosed with diseases which result in higher payments increased far faster at many Medicare Advantage health plans than among people on standard Medicare. Exaggerating the severity of a medical condition to raise fees is known in medical circles as “upcoding.”
For instance, “drug and alcohol dependence” is as much as eight times more common in the highest coding Medicare Advantage plans than among patients in standard Medicare.
Even more striking, according to the study, is how much higher reported diabetes rates have been in certain health plans than others. The study tracked rapid rises in many medical conditions from 2004, when risk scoring began, through last year, and made them public for the first time.
Overall, diabetes with serious complications, which pays higher rates, was reported up to five times more often among enrollees in some Medicare Advantage plans than among people on standard Medicare. Conditions such as major depression also were far more common in some plans than others.
Holly J. Cassano, a medical coding consultant in Florida, said the government’s decision to make the billing data public was “an enormous leap … in the right direction for continued transparency in all areas of health care.”
“The main issue, now that it has been revealed, is ‘upcoding’, which no one likes to discuss, but the data is in black and white and speaks volumes,” Cassano, CEO of Accucode Consulting, wrote in an email.
Medicare Advantage enjoys solid political backing on Capitol Hill and has successfully fought back efforts by the Obama administration to make substantial cuts to its payment rates. Lobbying by the insurance industry and the fear of angering seniors also has largely quieted concerns in Congress that Medicare Advantage plans can be a poor value for taxpayers.
Congress recognized problems with Medicare Advantage coding as far back as 2005, when lawmakers directed CMS to find ways to cut back on rising, and presumably unjustified, risk scores. But CMS didn’t act until 2010, when it adjusted risk scores downward. The Affordable Care Act theoretically requires further reductions, but the political storm over the planned cuts has made their fate uncertain.
CMS has cut back payment levels for several diseases that appear to have prompted upcoding by Medicare Advantage plans. But the study’s authors noted that health plans are likely to find new conditions to replace lost revenue.
Even though the study does not name plans, it says all those examined had at least 10,000 members and that one plan among the highest billers had more than 200,000 members. The study indicates that the longer patients stay in Medicare Advantage, the more their risk scores rose, suggesting that government’s failure to reel in coding has been costly.
The Center for Public Integrity has sought similar billing data from CMS for the past year as well as the names of Medicare Advantage plans that have been suspected of overbilling the government — and by how much. In late May, the Center sued the Department of Health and Human Services to make its Medicare Advantage audits and other related records public. The lawsuit is pending.
Last month, CMS published a draft regulation that would allow for “a formal process to recoup overpayments” made to the health plans. A final decision on the proposal is due by Nov. 1.
HHS Report: Medicare Advantage Plans Exaggerate Members …
Washington, DC, United States (KaiserHealth) – Many Medicare Advantage health plans routinely overbill the government for treating elderly patients — and have done it for years, a federal study shows.
Department of Health and Human Services researchers found that many plans exaggerate how sick their patients are and how much they cost to treat. Medicare expects to pay the privately run plans — an alternative to traditional Medicare —$160 billion this year.
The HHS study does not accuse any specific insurers of wrongdoing or name the plans that were scrutinized. But the researchers offer the most comprehensive evidence to date that suspect billing practices have been common across much of the Medicare Advantage industry and are likely to get worse unless officials crack down.
“Further policy changes will likely be necessary,” the study concludes.
Congress created Medicare Advantage in 2003 to encourage private insurance companies to venture into the senior care market. The plans now insure 16 million elderly and disabled people, nearly a third of those eligible for Medicare. They are popular with seniors because they often provide extra benefits, such as eyeglasses and dental care, and can cost less out-of-pocket than standard Medicare.
Medicare pays the Advantage health plans higher rates for sicker patients and less for healthy people using a complex formula called a “risk score.” But the HHS study spells out several ways health plans have inflated those scores, from reporting surprisingly high levels of medical conditions such as alcohol or drug dependence to billing for an inordinately high number of patients with complications of diabetes.
Despite its broad implications for Medicare spending, the study by HHS researchers Richard Kronick and W. Pete Welch has attracted scant notice in Washington. It was quietly posted late last month on an online research site run by the Centers for Medicare & Medicaid Services, part of HHS.
Kronick directs the HHS Agency for Healthcare Research and Quality, whose mission is to improve health care delivery. Welch works for the HHS Office of the Assistant Secretary for Planning and Evaluation. The authors note that the study does not necessarily reflect HHS views, but both offices are influential in advising the government on policy matters.
CMS officials declined comment.
“This is clearly impacting what taxpayers are paying for Medicare Advantage, I think, not in a good way,” said Dr. David Wennberg, a researcher at the Dartmouth Institute for Health Policy and Clinical Practice who has studied Medicare billing trends.
Health care fraud expert Malcolm Sparrow, a professor at Harvard’s Kennedy School of Government, said the problems with billings based on risk scores reveal how “financial incentives” can improperly influence how medicine is practiced.
“The problem seems significant,” he said.
The new study amplifies the findings of a Center for Public Integrity investigation published in June. The investigation found that Medicare made nearly $70 billion in “improper” payments — mostly overcharges from inflated risk scores — to Medicare Advantage plans from 2008 through 2013. The center’s investigation also found that risk scores rose much faster in some health plans than others and that federal officials repeatedly yielded to industry pressure to minimize efforts to recoup overpayments.
Medicare Advantage plans are paid a set monthly fee for each patient based on the risk scores, and the government largely trusts the health plans to report the health status of people they enroll. About 70 medical conditions can boost payment rates.
Clare Krusing, a spokeswoman for America’s Health Insurance Plans, the industry’s trade group, said the higher billing resulted from health plans working with patients “to understand their specific health conditions, and consequently make sure they get the care they need.”
“What was not highlighted (in the study) is the fact that these programs have demonstrated improved quality in patients’ health,” she wrote in an email.
However, the study concludes that people who join Medicare Advantage plans are healthier than those who remain on standard Medicare, which pays doctors and hospitals for each service they provide. The study also says it’s “unlikely” the higher payments health plans derive from diagnosing more medical conditions “are related to substantial health benefits.”
In short, the numbers of patients diagnosed with diseases which result in higher payments increased far faster at many Medicare Advantage health plans than among people on standard Medicare. Exaggerating the severity of a medical condition to raise fees is known in medical circles as “upcoding.”
For instance, “drug and alcohol dependence” is as much as eight times more common in the highest coding Medicare Advantage plans than among patients in standard Medicare.
Even more striking, according to the study, is how much higher reported diabetes rates have been in certain health plans than others. The study tracked rapid rises in many medical conditions from 2004, when risk scoring began, through last year, and made them public for the first time.
Overall, diabetes with serious complications, which pays higher rates, was reported up to five times more often among enrollees in some Medicare Advantage plans than among people on standard Medicare. Conditions such as major depression also were far more common in some plans than others.
Holly J. Cassano, a medical coding consultant in Florida, said the government’s decision to make the billing data public was “an enormous leap … in the right direction for continued transparency in all areas of health care.”
“The main issue, now that it has been revealed, is ‘upcoding’, which no one likes to discuss, but the data is in black and white and speaks volumes,” Cassano, CEO of Accucode Consulting, wrote in an email.
Medicare Advantage enjoys solid political backing on Capitol Hill and has successfully fought back efforts by the Obama administration to make substantial cuts to its payment rates. Lobbying by the insurance industry and the fear of angering seniors also has largely quieted concerns in Congress that Medicare Advantage plans can be a poor value for taxpayers.
Congress recognized problems with Medicare Advantage coding as far back as 2005, when lawmakers directed CMS to find ways to cut back on rising, and presumably unjustified, risk scores. But CMS didn’t act until 2010, when it adjusted risk scores downward. The Affordable Care Act theoretically requires further reductions, but the political storm over the planned cuts has made their fate uncertain.
CMS has cut back payment levels for several diseases that appear to have prompted upcoding by Medicare Advantage plans. But the study’s authors noted that health plans are likely to find new conditions to replace lost revenue.
Even though the study does not name plans, it says all those examined had at least 10,000 members and that one plan among the highest billers had more than 200,000 members. The study indicates that the longer patients stay in Medicare Advantage, the more their risk scores rose, suggesting that government’s failure to reel in coding has been costly.
The Center for Public Integrity has sought similar billing data from CMS for the past year as well as the names of Medicare Advantage plans that have been suspected of overbilling the government — and by how much. In late May, the Center sued the Department of Health and Human Services to make its Medicare Advantage audits and other related records public. The lawsuit is pending.
Last month, CMS published a draft regulation that would allow for “a formal process to recoup overpayments” made to the health plans. A final decision on the proposal is due by Nov. 1.
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– Provided by Kaiser Health News.
ICD-10 Deadline and Testing Details Published by CMS « Manage …
ICD-10 Deadline and Testing Details Published by CMS
On July 31, the Department of Health and Human Services (HHS) issued a rule (CMS-0043-F) finalizing October 1, 2015 as the new compliance date for health care providers and health plans to transition to ICD-10. ICD-10 represents a significant code set change that impacts the entire health care community.
When it comes to ICD-10, my general advice to practices is to “Forget About It” (until 2015.) You do need to understand the lingo, however, and make sure you have the basics down. If you’ve never explored your MAC website, now is a good time to do that. Sign up to get email notices from your MAC so you can be sure you won’t miss anything important.
But first, a little vocabulary for this article:
MAC = Medicare Administrative Contractor: this is the company that carries out Medicare’s instructions for accepting claims and approving claim payments. Some rules are set by Medicare for all MACs, but Medicare gives MACs some independence in setting their own rules. Just who is your MAC? Click on your state to find out who is your Part B (physician fee-for-service) Medicare administrator is on the Interactive Map Here.
DME = Durable Medical Equipment: items such as wheelchairs, crutches and splints.
NCD = National Coverage Determination: these are the rules that Medicare sets that all MACs must follow. Because the NCDs references diagnoses related to services, all NCDs will change with ICD-10.
LCD = Local Coverage Determination: these are the rules that Medicare allows each MAC to set themselves. Because the LCDs reference diagnoses related to services, all LCDs will change with ICD-10. These used to be called LMRP or Local Medical Review Policies.
FFS = Fee-For-Service: Reimbursement system where a separate payment is made to a health-care provider for each medical service rendered to a patient.
Trading Partner: An Electronic Data Interchange (EDI) Trading Partner is defined as any Medicare customer (e.g., provider/supplier, billing service, clearinghouse or software vendor) that transmits to, or receives electronic data from, Medicare.
RA = Remittance Advice: a paper or electronic document supplied by the insurance payer that provides notice of and explanation reasons for payment, adjustment,denial and/or uncovered charges of a medical claim. An ERA is an Electronic Remittance Advice. Sometimes it is called an EOB or Explanation of Benefits, although that term is used more frequently to describe the paper document that goes to the patient to describe how the payer has paid the provider/physician.
DRG = Diagnosis-Related Group: is a system to classify hospital cases into one of originally 467 groups, with the 467th group being “Ungroupable”.
As the ICD-10 implementation date of October 1, 2015, approaches, the Centers for Medicare and Medicaid Services (CMS) is taking a comprehensive four-pronged approach to preparedness and testing for ICD-10 to ensure that CMS as well as the Fee-For-Service (FFS) provider community is ready.
The four-pronged approach includes:
- CMS internal testing of its claims processing systems;
- Provider-initiated Beta testing tools;
- Acknowledgement testing; and
- End-to-end testing.
CMS Internal Testing of Claims Processing
CMS began installing and testing system changes to support ICD-10 in 2011. As of October 1, 2013, all Medicare FFS claims processing systems were ready for ICD-10 implementation. CMS continues to test its ICD-10 software changes with each quarterly release.
Provider-Initiated Beta Testing Tools
CMS recommends that you leverage the variety of Beta versions of its software that include ICD-10 codes as well as National Coverage Determination (NCD) and Local Coverage Determination (LCD) code crosswalks to test the readiness of your own systems. The following testing tools are available for download:
- NCDs converted from International Classification of Diseases, 9th Edition (ICD-9) to ICD-10 is located here. (Note: as of this writing there are only about 30 conversions published – you can easily scan down them to see if any will impact your practice and check back regularly over the next year.)
- The ICD-10 Medicare Severity-Diagnosis Related Groups (MS-DRGs) conversion
project (along with payment logic and software replicating the current MS-DRGs),
which used the General Equivalence Mappings to convert ICD-9 codes to International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM) codes, located here on the CMS website. (Note: this will not relate to physician practices.) - A pilot version of the October 2013 Integrated Outpatient Code Editor (IOCE) that
utilizes ICD-10-CM located here on the CMS website. This breaks ICD-10 into the following categories: Adult diagnoses, Newborn diagnoses, Pediatric diagnoses,
Maternity diagnoses, Diagnoses for females only, Diagnoses for males only, Manifestation Diagnoses, and Mental health diagnoses. (Pretty cool, huh?) The final version of the IOCE is scheduled for release this/next month.
Acknowledgment Testing
Providers, suppliers, billing companies, and clearinghouses are welcome to submit acknowledgement test claims anytime up to the October 1, 2015, implementation date. In addition, CMS will be highlighting this testing by offering three separate weeks of ICD-10 acknowledgement testing. These special acknowledgement testing weeks give submitters access to real-time help desk support and allows CMS to analyze testing data. Registration is not required for these virtual events.
All MACs and the DME MAC Common Electronic Data Interchange (CEDI) contractor will promote this ICD-10 acknowledgement testing with trading partners. This testing allows all providers, billing companies, and clearinghouses the opportunity to determine whether CMS will be able to accept their claims with ICD-10 codes. While test claims will not be adjudicated, the MACs will return an acknowledgment to the submitter (a 277A) that confirms whether the submitted test claims were accepted or rejected. MACs and CEDI will be appropriately staffed to handle increased call volume on their Electronic Data Interchange (EDI) help desk numbers, especially during the hours of 9:00 a.m. to 4:00 p.m. local MAC time, during these testing weeks. The testing weeks will occur in November 2014, March 2015, and June 2015. For more information about acknowledgement testing, refer to the information on your MAC’s website.
End-to-End Testing
During 2015, CMS plans to offer three separate end-to-end testing opportunities. Each opportunity will be open to a limited number of providers that volunteer for this testing. As planned, approximately 2,550 volunteer submitters will have the opportunity to participate over the course of the three testing periods. End-to-end testing includes the submission of test claims to Medicare with ICD-10 codes and the provider’s receipt of a Remittance Advice (RA) that explains the adjudication of the claims. The goal of this testing is to demonstrate that:
- Providers or submitters are able to successfully submit claims containing ICD-10 codes to the Medicare FFS claims systems;
- CMS software changes made to support ICD-10 result in appropriately adjudicated claims (based on the pricing data used for testing purposes); and
- Accurate RAs are produced.
The sample will be selected from providers, suppliers, and other submitters who volunteer to participate. Information about the volunteer registration will be available shortly. Volunteer submitters will be selected nationwide to participate in the end-to-end testing. The sample group of participants will be selected to represent a broad cross-section of provider types, claims types, and submitter types.
Additional details about end-to-end testing will be available soon.
Claim Submission Alternatives
If you are not be able to complete the necessary systems changes to submit claims with ICD-10 codes by October 1, 2015, you should investigate downloading the free billing software that CMS offers via their MAC websites. The software has been updated to support ICD-10 codes and requires an internet connection. This billing software only works for submitting FFS claims to Medicare. It is intended to provide submitters with an ICD-10 compliant claims submission format; it does not provide coding assistance. Alternatively, all MACs offer provider internet portals, and a subset of these MAC portals offer claims submission; providers submitting to this subset of MACs may choose to use the portal for submission of ICD-10 compliant claims. Register in the portals that offer claims submission to ensure that you have the flexibility to submit professional claims this way as a contingency. More information may be found on your MAC’s website.
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Online Medical Billing Coding Transcription And Medicare Training
ICD-10 Delayed Until October 1, 2015, May Add $1B to $6.8B in Costs
The deadline for the implementation of ICD-10 has been extended for one year to October 1, 2015, according to the advance release of an HHS final rule. Required by the Protecting Access to Medicare Act of 2014 (PAMA) (P.L. 113-93), which states that ICD-10 may not be adopted earlier than October 1, 2015, the extension is estimated to add 10 to 30 percent to the costs already budgeted or spent by affected health care entities to meet the original October 1, 2014 deadline, the advance release states.
Background
ICD-10, the tenth iteration of the International Classification of Diseases, is a set of codes used to classify diagnoses and procedures for the submission of claims to Medicare and private insurance. According to the press release announcing the final rule, the current iteration, ICD-9, “contains outdated, obsolete terms that are inconsistent with current medical practice, new technology and preventive services.” Health care providers and specialty groups collaborated with CMS to develop more accurate, detailed codes reflecting advances in medicine and medical technology.
“ICD-10 codes will provide better support for patient care, and improve disease management, quality measurement and analytics,” said CMS Administrator Marilyn Tavenner in the press release. “For patients under the care of multiple providers, ICD-10 can help promote care coordination.” The final rule cites benefits of ICD-10, including greater specificity of diagnosis, improved quality measurement and reporting, improved tracking of illnesses, and greater accuracy of reimbursement.
Providers’ ICD-10 Preparation
In a survey of 5,000 members of the American Academy of Professional Coders, 75 percent reported they are making progress in preparation toward the implementation of ICD-10. Twenty-five percent of those surveyed reported they had completed all necessary ICD-10 training, and 13 percent said they were prepared for the October 1, 2014 implementation. Twenty-three percent said they were actively testing with their vendors when the PAMA was enacted.
Delay of Implementation
The PAMA states that the Secretary of HHS may not adopt ICD-10 under Health Insurance Portability And Accountability Act of 1996 (P.L. 104-191) prior to October 1, 2015. HHS will implement ICD-10 at the earliest possible time, October 1, 2015, as a “delay longer than 1 year would slow or even stop progress towards ICD-10 implementation.” The new deadline will also “allow the industry to begin reaping the benefits of ICD-10 as soon as possible.” The final rule also stated that the one-year delay is the least expensive option for the industry, as any longer delay may render ICD-10 obsolete and diminish investments already made toward preparing for the transition. Covered entities will be required to continue using ICD-9 through September 30, 2015.
Waiver of Proposed Rulemaking
The Administrative Procedure Act “allows HHS to waive normal rulemaking requirements if it finds that notice and comment procedures are impracticable, unnecessary, or contrary to the public interest.” HHS waived notice and comment rulemaking to give covered entities enough time to know how to proceed.
Anticipated Effects
The final rule states that all HIPAA-covered entities will be affected by the delay. Because many government health programs were prepared to be compliant on October 1, 2014, those programs will incur costs from the delay. Systems that have been programmed to accept and process ICD-10 codes on October 1, 2014 will have to be reconfigured, resulting in costs from extended contracts and reprogramming work. HHS estimates Medicare will incur a total cost of $5 to $10 million, and state Medicaid agencies will incur a total of $169 to $182 million in costs. Hospitals and large providers will be required to maintain staffing levels, renegotiate contracts, and retest systems, resulting in a total cost of approximately $409 million to $3.7 billion. In total, the final rule estimated the total additional cost to commercial entities to be $1.6 billion to $6.8 billion.
CMS did not estimate the cost to small providers “because these costs were negligible.” Some small providers may even benefit from the extension, according to the final rule, depending on their current level of preparation.
Robert Hansen's Blog: Transition from ICD9 to ICD10 Codes …
This fall, the US government requires pretty much all health care providers to transition from the old set of codes for medical diagnoses, known as ICD9, to a new larger set of codes, ICD10. According to the Center for Medicare and Medicaid Services, ICD10 allows for 7 digits while ICD9 allowed only for 5.
So under the new system, we could have up to 9,999,999 different codes while under the old there was only the possibility for 99,999 — and as the ICD10 is alphanumeric, this is an understatement. I guess however they never maxed out on usage of the total possibilities, as the article referenced below says ICD9 had only 13,000 distinct codes while ICD10 will have only 68,000. Quite a difference to be sure, and still room to grow. CMS provides a fact sheet if you want to learn a bit more.
The key thing is that these diagnostic codes are used for billing purposes. Submit a code to Medicare, and you get the payment associated with that code.
Naturally the pundits are having a grand time with this one. Here are the “16 most absurd ICD10 codes.” Here are just a couple:
Medicare Part DMedicare Remittance Advice Codes
Medicare Part DMedicare Remittance Advice Codes (pdf download)
Medicaid Provider Billing Workshop – Health Care Authority
Obtain the Remittance Advice. • Adjust or Void a …. If client has Medicare Part A
or Part B this information will be shown with the Medicare …. Enter the Billing
Provider NPI and taxonomy code. ✓ This will ….. AMT01 = D-Medicare Amount.
Paid.
rev. july 2, 2013 nebraska department of medicaid services manual …
codes adopted by the federal Secretary of Health and Human Services and
includes American … months from the date of the Medicare remittance advice;. 3.
Mercy Care Advantage MCA Provider Manual … – Mercy Care Plan
Part D – Medicare Prescription Drug Plan: helps pay for prescription drugs,
certain …. Electronic Data Information, Electronic Fund Transfer, Electronic
Remittance Advice …. eligibility at 602-263-3000 and use Express Service Code
629.
New Medicare Policy for Dialysis Providers – Medi-Cal
manual section, under “Split Billing: More Than 15 Line Items for Part B …
Medicare National Standard Intermediary Remittance Advice … AMOUNT
REMARK CODES …. Figure d. Medicare National Standard Intermediary
Remittance Advice …
http://www.ngsmedicare.com/ngs/wcm/connect/028e39e7-53dd-46cd-95f8-081043983da5/197_1213_JBC_R4.pdf?MOD=AJPERES&CACHEID=028e39e7-53dd-46cd-95f8-081043983da5
Jurisdiction B Connections, December 2013 – National Government …
Jul 1, 2013 … remittance advice (ERA) and electronic funds transfer (EFT) to take ….. They are
part of the Medicare Program, and sometimes called “Part C.” … codes indicated
on the remittance advice for additional information …… Show consumers how to
evaluate the various Medicare Part D, Medicare supplement, and …
http://www.justice.gov/usao/iln/pr/rockford/2014/pr0125_01a.pdf
Complaint – Department of Justice
Jan 24, 2014 … namely, Medicare, and to obtain money owned by and under the custody … fraud
in violation of Title 18, United States Codes, Section 1347. … Part B claims from
the Medicare Trust Fund. ….. (d) Medicare and insurance billing/payment records,
including remittance advices and claims for services provided;.
https://providers.amerigroup.com/ProviderDocuments/TXTX_CaremarkPharmacyProviderTraining.pdf
Caremark Pharmacy Provider Training – Providers – Amerigroup
Prescription Origin Code. • Benefit Plan … DUR Conflict Codes and Messages ….
Prescriptions reimbursable by Medicare Part D (Medicare Rx) are not eligible for
….. Pharmacies will continue to receive their remittance advice (paper) or 835.
https://medicareespanol.fcso.com/Publicaciones/2002/156396.pdf
C:Boletin Medicare InformaMed
Oct 1, 2002 … Advice and Medicare Summary Notice) dated October 1, 2002 and ….. D)
Medicare Part A&B Workplan …. Medicare Remittance Advice Remark Codes: A
national administrative code set for providing either claim-level.
https://advocacy.gha.org/Portals/1/Documents/Compliance/Newsletters/July2013_0718_FINAL.pdf
CONTENTS – Advocacy – Georgia Hospital Association
Jul 1, 2013 … there is no way to identify the interest paid on the remittance advice. …. Incorrectly
Submitting Part B Rebilling Claims with Reason Code 39011 …. cost-sharing
obligations under Medicare Part B, Medicare Part D, Medicare.
http://www.bcbsnc.com/assets/providers/public/pdfs/blue-medicare-providers/pronewsletter-fallwinter10.pdf
Reminder about Blue Medicare HMO and Blue Medicare ppO …
Blue Medicare HMOSM and Blue Medicare PPOSM products. FALL/WINTER ….
payment remittance for a processed claim. (Members … of submitted CPT® and
HCPCS codes. ClaimCheck …. + Submit Medicare Part-D vaccine claims ….. *C/D
– Medicare Part C/ Medicare Part D …. with proactive advice, you can help them.
http://www.healthlawyers.org/News/Health%20Lawyers%20Weekly/Documents/051311/algnment_notice.pdf
Microsoft Word – 0137410-1216367-pi.doc – The American Health …
May 16, 2011 … ADDRESSES: In commenting, please refer to file code CMS- …. As part of the
Medicare-Medicaid Coordination Office’s efforts to ….. remittance advice, the
facility cannot receive …. Parts C and D: Medicare allows beneficiaries.
http://www.providers.kaiserpermanente.org/info_assets/cpp_oh/oh_provman_section12_new_jun_2012.pdf
Definitions, last revised June, 2012 – Kaiser Permanente …
A commercial code editor application utilized by Harrington Health for Self-
Funded alternatives. Clean Claim: …. Medicare Part D (Medicare Prescription
Drug Coverage – Part D) … standard medical Claims and remittance advice
transactions.
http://www.catamaranrx.com/uploadedFiles/Investors/Annual_Reports/AR-2012.pdf
2012 – Catamaran
Registrant’s phone number, including area code: (800) 282-3232 ….. pharmacy
claims management, Medicare Part D services, benefit design consultation, ….
gives providers the ability to view claim details, remittance advice and eligibility,
and …. Medicare Part D. Medicare Part D is a program that subsidizes the costs of
….
http://www.medicalcodingpro.com/support-files/MCP-75-question-exam-1.pdf
Medical Coding Pro 75 Questions & Answers Exam #1
b. remittance advice … The Medicare CCI (Correct Coding Initiative) edits indicate
that code 29877 is not a …. A statement sent to the provider to explain payments
made by third party payers is … d. Medicare administrative contractor (MAC).
http://www.bcbsfl.com/wps/wcm/connect/7722b00046a6e69aaf79bfbca0217077/Guide+for+Group+Administrators_20222.pdf?MOD=AJPERES
Guide for Group Administration – Florida Blue
Medicare Advantage, Medicare Part D, Medicare supplement …. D. Compete
section III below with the complete name, address, city, state and zip code of.
http://www.healtheconnections.org/files/HealthPlanning/files/ProviderDatabase/data%20set%20documentation/11-Medicare_Intregity_Manual_pim83c15.pdf
Medicare Program Integrity Manual – HealtheConnections
15.4.3 – Medicare Advantage Plans and Other Managed Care Organizations …
15.4.5 – Manufacturers of Replacement Parts/Supplies for Prosthetic Implants or.
Implantable …. 15.21.5 – Alert Codes …… D. Medicare Subparts Paper – Text …
transactions that they conduct with Medicare (such as electronic claims,
remittance.
http://www.ncdhhs.gov/dma/bulletin/pdfbulletin/0902specrev111402.pdf
NC DMA: September 2002 Special Medicaid Bulletin – Medicare Part B
Medicaid claims when Medicare Part B is the recipient’s primary payer. …
services telephone number, and 24-hour medical advice line telephone number.
…. enter the Medicare payer code in form locator 50 and Medicare payment …..
Please Check: D Claim Inquiry D Medicare Override DTime Limit Override DThird
Party.
http://www.ct.gov/dph/lib/dph/infectious_diseases/immunization/adults/vaccination_billing_complete_7_2_12_(2).pdf
Local Health Department Vaccination billing Project Model – CT.gov
Jun 29, 2012 … Note: Application to become a public health Medicare Part “B” provider is an
involved …. d. Medicare and Medicaid #’s ….. appropriate billing codes in claims
submitted to the Participating Payers. … functionality to allow Provider to
download any claim status reports or payment remittance advice reports that.
https://www.publicpartnerships.com/programs/WestVirginia/WVTBI/documents/EE_Packet/Complete%20EE%20Packet.pdf
Complete Employee Packet – PCG Public Partnerships
May 1, 2012 … PPL will withhold Social Security, Medicare (FICA), and state and federal income
taxes. … Your current city, state, and Zip Code …. Either party may terminate this
agreement by notifying the other party and …. d Medicare t ….. withholding, etc. on
a document called a “Remittance Advice” that is mailed to you.
http://deloitte.wsj.com/cfo/files/2012/08/deloitte_healthcare_memo_2012-08-27.pdf
Read the full Health Reform Memo for August 27 – Wall Street Journal
Aug 27, 2012 … Medicare reforms to be in spotlight at conventions … understand their system of
care; it’s a vital part of their education and a source of national …. B, and D),
Medicare beneficiaries with incomes above 150% …. and electronic remittance
advice transaction—estimated savings of up to $4.5 billion over ten.
18 Statistics on Payer Mix by ASC Size – Becker's ASC Review
Here are 18 statistics on ambulatory surgery center payer mix based on the number of operating rooms, according to VMG Health‘s 2012 Intellimarker Ambulatory Surgical Center Financial & Operational Benchmarking Study.
One to two ORs
• Medicare: 29 percent
• Medicaid: 4 percent
• Commercial: 54 percent
• Workers’ compensation: 3 percent
• Self-pay: 1 percent
• Other: 6 percent
Three to four ORs
• Medicare: 22 percent
• Medicaid: 3 percent
• Commercial: 59 percent
• Workers’ compensation: 4 percent
• Self-pay: 2 percent
• Other: 5 percent
More than four ORs
• Medicare: 23 percent
• Medicaid: 4 percent
• Commercial: 62 percent
• Workers’ compensation: 3 percent
• Self-pay: 2 percent
• Other: 3 percent
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