CPB HOLIDAY CLOSURE DATES
Just a reminder that CPB will be closed on Tuesday, December 25th & January 1st for the Christmas & New Years holidays. Monday, December 24th we will be open from 9:00 – 1:00. We hope each of you enjoy your own special holidays.
Hospital Consult vs. Patient Visit
The question is whether there was a request for consultation for the management of a problem that another physician requested under the definition of a Consult or if the patient was in the hospital admitted by someone else and you are merely rounding or continuing management of an ongoing problem while the patient is in the hospital.
Deposit of Checks Without Leaving Your Office
We are now seeing bank activity offering the option to deposit your checks without going to the bank. You simply scan the checks and send them via internet to the bank where they process the file electronically. We have not investigated the cost (if any) but wanted to let you know of this new option. If you are interested your bank will have the details if they offer it.
2008 PART B DEDUCTIBLE
The Centers for Medicare & Medicaid Services (CMS) announced the Part B annual deductible for 2008 is $135.00 (up from $131 for 2007).
ANNUAL CHARGE FORM CHANGES
This is a good time to review your Charge forms for new CPT, ICD-9 and HCPCS codes and to decide whether to add your new NPI # before you re-order. The Charge form is a key part of any insurance audit so ensuring it is current is important. CPB will be glad to review all codes on the form for you and provide any necessary corrections at no cost. Many clients also have their Tax ID#, Medicare # or other numbers on their Charge form but they are not required unless the patient does their own billing.
PQRI 2008
The 2008 Medicare Physician Fee Schedule (MPFS) Final Rule, effective for services on or after January 1, 2008, is on display in the Federal Register and was published on November 27, 2007. The rule identifies 119 measures CMS has selected for eligible professionals to use to report quality-of-care information under the 2008 PQRI. The rule can be found at: http://www.cms.hhs.gov/center/physician.asp. The Physician Quality Reporting Initiative (PQRI) provisions begin on page 653.
A summary of these provisions is available at: http://www.cms.hhs.gov/PQRI/downloads/2008PQRIMPFSSummary.pdf .
CMS Online Internet Applications
The Centers for Medicare & Medicaid Services (CMS) has announced new online enterprise applications that will allow Medicare fee-for-service providers to access, update, and submit information over the Internet. Details of these provider applications will be announced as they become available. Even though these new internet applications are not yet available, CMS recommends that providers take the time now to set up their online account so they can access these applications as soon as they are available. The first step is for the provider or appropriate staff to register for access through a new CMS security system known as the Individuals Authorized Access to CMS Computer Services - Provider Community (IACS-PC). This does NOT apply to DMEPOS suppliers at this time. This is the first step in the PECOS On-Line Provider Enrollment process which is expected to begin in about 60 days.
A recent MLN Matters article, the first in a new series on IACS-PC, addresses key questions and answers about the registration process and can be found at
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0747.pdf on the CMS website.
What is particularly important is that a provider can designate an authorized representative to access the system on their behalf. This will allow physicians and other providers to designate the billing company as a designated representative. As the designated representative, the billing company will be able to complete the on-line enrollment, as well as update information as necessary.
A key point is when someone should register as an “individual” versus an “organization”. If the provider registers as an “individual” ONLY he or she is authorized to enter or change information. If the provider wishes to allow someone else access (an employee, billing company, etc.), then he/she must register as an “organization” even if it is a solo practicing physician.
CPB will be glad to do this on your behalf at no cost – just fax a request to Rich.
Monday, December 3, 2007
November 2007
NPI #’s
CMS finally released the NPI number registry on September 5, 2007 & we are working on loading all referring physician NPI #’s in our database. CPB, as has nearly every other practice and billing service, continues to deal with various related minor insurance company NPI # issues. This is because CMS gave every insurance company in the USA (over 2,000 of them!) the latitude to decide when they will require various NPI # & related fields to be sent. So far, all such issues have been successfully addressed.
New Patient Visits Definition
The CPT book defines New Patient as a patient not seen within the previous 3 years. Billing a new patient office visit code (99201-99205) within that timeframe is considered fraud. Even if a patient was seen for an MVA or a Workman's Comp case, this does not make them a new patient unless they are beyond the three-year period.
If a CPB client sends through such a charge we will fax you a request to verify the proper established office visit code (99211-99215) to bill.
Medicare Edits
NGS Medicare – the NJ Medicare Carrier sent this email on October 11, 2007.
“The following is effective immediately and also impacts pending claims already in the Multi-Carrier System (MCS).
If the beneficiary name and the Health Insurance Claim Number (HICN) submitted on a claim do not exactly match what appears on the patient's Medicare card, then the claim will reject. For example, if the submitted claim reads "Jane Doe" but the Medicare card reads "Jane M. Doe'" the claim will not process. It is required that the information match exactly.
The Claims Processing Manual, Chapter 1, Section 80.3.2.1.1 - Carrier Data Element Requirements, states: "Carriers must return a claim as unprocessable to a provider of service or supplier and use the indicated remark codes if the claim is returned through remittance advice or notice process."
Item #2 under this paragraph goes on to state: "If a claim lacks a valid patient's last and first name as seen on the patient's Medicare card or contains an invalid patient's last and first name as seen on the patient's Medicare card."
CPB STRONGLY recommends that your staff begin to make a copy of ALL patient Medicare cards and send them to CPB – even for established patients – so we can ensure all patient files are current to avoid rejections.
DMERC A EFT Changes
Received via email on October 12, 2007 from NHIC – the DMERC A Carrier (yes it was after the fact!):
“Effective October 2, 2007, provider's receiving EFT payments from NHIC will no longer see "NHIC MEDICARE PART B" printed on their bank statements. This wording will be replaced with NHIC's tax identification number (751532981). The check number will continue to be printed.
CURRENT REF*TN*881234567*NHIC MEDICARE PART B
NEW TRN*1*881234567*751532981
These changes will have no effect on a provider's Medicare payments.”
CMS Proposes A New System of Records
On Wednesday, September 12, 2007, the Department of Health and Human Services through the Centers for Medicare and Medicaid proposed to establish a new system of records titled, "Performance Measurement and Reporting System (PMRS), System No. 09-70-0584."
The PMRS will serve as a master system of records to assist in projects to provide transparency in health care on a broad-scale. This enables consumers to compare the quality and the price of health care services so they can make informed choices among individual physicians, practitioners and providers of services.
CMS or a non-Quality Improvement Organization (non-QIO) contractor would make individual physician-level performance measurement results available to Medicare beneficiaries by posting it on a public Website and other various methods of data dissemination. The purpose of disclosing individual-specific information is to promote more informed choices by Medicare beneficiaries about their Medicare coverage options. Furthermore, CMS does not anticipate an unfavorable effect on individual privacy because PMRS would be established in accordance with the principles and requirements of the Privacy Act of 1974.
The new system, including routine uses, will become effective 30 days from the September 12th Federal Register publication of the notice, or from the date it was submitted to the OMB and Congress, whichever is later, unless CMS receives comments that require alterations to the notice. CMS accepts comments on all portions of the notice.
The public should address comments to: CMS Privacy Officer, Division of Privacy Compliance, Enterprise Architecture and Strategy Group, Office of Information Services, CMS, Room N2-04-27, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.
The September 12, 2007, Federal Register announcement includes detailed descriptions of each section of the notice. It is available at:
http://a257.g.akamaitech.net/7/257/2422/01jan20071800/edocket.access.gpo.gov/2007/pdf/E7-17962.pdf
CMS finally released the NPI number registry on September 5, 2007 & we are working on loading all referring physician NPI #’s in our database. CPB, as has nearly every other practice and billing service, continues to deal with various related minor insurance company NPI # issues. This is because CMS gave every insurance company in the USA (over 2,000 of them!) the latitude to decide when they will require various NPI # & related fields to be sent. So far, all such issues have been successfully addressed.
New Patient Visits Definition
The CPT book defines New Patient as a patient not seen within the previous 3 years. Billing a new patient office visit code (99201-99205) within that timeframe is considered fraud. Even if a patient was seen for an MVA or a Workman's Comp case, this does not make them a new patient unless they are beyond the three-year period.
If a CPB client sends through such a charge we will fax you a request to verify the proper established office visit code (99211-99215) to bill.
Medicare Edits
NGS Medicare – the NJ Medicare Carrier sent this email on October 11, 2007.
“The following is effective immediately and also impacts pending claims already in the Multi-Carrier System (MCS).
If the beneficiary name and the Health Insurance Claim Number (HICN) submitted on a claim do not exactly match what appears on the patient's Medicare card, then the claim will reject. For example, if the submitted claim reads "Jane Doe" but the Medicare card reads "Jane M. Doe'" the claim will not process. It is required that the information match exactly.
The Claims Processing Manual, Chapter 1, Section 80.3.2.1.1 - Carrier Data Element Requirements, states: "Carriers must return a claim as unprocessable to a provider of service or supplier and use the indicated remark codes if the claim is returned through remittance advice or notice process."
Item #2 under this paragraph goes on to state: "If a claim lacks a valid patient's last and first name as seen on the patient's Medicare card or contains an invalid patient's last and first name as seen on the patient's Medicare card."
CPB STRONGLY recommends that your staff begin to make a copy of ALL patient Medicare cards and send them to CPB – even for established patients – so we can ensure all patient files are current to avoid rejections.
DMERC A EFT Changes
Received via email on October 12, 2007 from NHIC – the DMERC A Carrier (yes it was after the fact!):
“Effective October 2, 2007, provider's receiving EFT payments from NHIC will no longer see "NHIC MEDICARE PART B" printed on their bank statements. This wording will be replaced with NHIC's tax identification number (751532981). The check number will continue to be printed.
CURRENT REF*TN*881234567*NHIC MEDICARE PART B
NEW TRN*1*881234567*751532981
These changes will have no effect on a provider's Medicare payments.”
CMS Proposes A New System of Records
On Wednesday, September 12, 2007, the Department of Health and Human Services through the Centers for Medicare and Medicaid proposed to establish a new system of records titled, "Performance Measurement and Reporting System (PMRS), System No. 09-70-0584."
The PMRS will serve as a master system of records to assist in projects to provide transparency in health care on a broad-scale. This enables consumers to compare the quality and the price of health care services so they can make informed choices among individual physicians, practitioners and providers of services.
CMS or a non-Quality Improvement Organization (non-QIO) contractor would make individual physician-level performance measurement results available to Medicare beneficiaries by posting it on a public Website and other various methods of data dissemination. The purpose of disclosing individual-specific information is to promote more informed choices by Medicare beneficiaries about their Medicare coverage options. Furthermore, CMS does not anticipate an unfavorable effect on individual privacy because PMRS would be established in accordance with the principles and requirements of the Privacy Act of 1974.
The new system, including routine uses, will become effective 30 days from the September 12th Federal Register publication of the notice, or from the date it was submitted to the OMB and Congress, whichever is later, unless CMS receives comments that require alterations to the notice. CMS accepts comments on all portions of the notice.
The public should address comments to: CMS Privacy Officer, Division of Privacy Compliance, Enterprise Architecture and Strategy Group, Office of Information Services, CMS, Room N2-04-27, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.
The September 12, 2007, Federal Register announcement includes detailed descriptions of each section of the notice. It is available at:
http://a257.g.akamaitech.net/7/257/2422/01jan20071800/edocket.access.gpo.gov/2007/pdf/E7-17962.pdf
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