CMA advocacy results in DHCS revaluing two CPT codes The California Medical Association (CMA) received a call from a physician member with concerns that the California Department of Health Care Services (DHCS) had priced a CPT code for destruction of up to 14 benign skin lesions (CPT 17110) at a higher level than it priced a more complex procedure for the destruction of 15 or more lesions (CPT 17111). CMA escalated the issue to DHCS so it could investigate. Upon further inspection and months of discussions, DHCS announced in October that it was increasing reimbursement on both codes, resulting ... April 5, 2018 CMA, General, Medi-Cal Dermatology, DHCS, Economic Advoacy, Billing/Coding, CPT, Department of Health Care Services, Medi-Cal 0 0 Comment Read More »
ICD-10 grace period ends October 1 Physicians are reminded that the Centers for Medicare and Medicaid Services' (CMS) one-year grace period for ICD-10-coded claims is coming to an end on October 1, 2016. As of that date, providers will be required to use the correct degree of specificity in their coded claims. When ICD-10 went live last year, CMS said it would not deny or audit claims as long as providers used codes in the correct "family" related to the treatment. According to CMS, the ICD-10 grace period ensured that contractors performing medical reviews would not deny ... September 12, 2016 Medi-Cal, Medicare Coding and Documentation, ICD-10, Billing/Coding 0 0 Comment Read More »
Aetna issues physician terminations over frequency of E/M visits The California Medical Association (CMA) has received several reports from physicians in the San Francisco Bay Area that they’ve received contract termination notices from Aetna due to their above-average use of high-level Evaluation and Management (E/M) codes. The termination letters, issued by Aetna in mid-January, advised physicians that upon review of claims for a one year period, their usage of high level E/M codes was “significantly outside the norm” of comparative physicians within their market. CMA has learned that approximately 40 physicians within the Northern California Aetna PPO network were ... July 6, 2015 General Billing/Coding, Coding and Documentation, Practice Resources, Aetna 0 0 Comment Read More »
Changes to Anthem Blue Cross reimbursement policies and claims software Anthem Blue Cross recently notified physicians of upcoming changes to the insurer’s reimbursement policies and claims editing software, called ClaimsXten. The changes will go into effect on July 1, 2015. Because of these changes, physicians may notice a difference in how certain codes and code pairs are adjudicated. Along with the notice, Anthem provided a comprehensive grid outlining the new, revised and existing reimbursement policies and claims editing rules as well as copies of Anthem’s reimbursement policies. The changes include additions to the types of service Anthem will consider bundled ... May 15, 2015 Managed Care Billing/Coding, Insurance, Managed Care, Anthem Blue Cross 0 0 Comment Read More »
ICD-10 training seminar dates and locations announced The California Medical Association (CMA), in partnership with your local county medical society and the California Medical Group Management Association (MGMA), is now offering statewide, two-day ICD-10 code set seminars this summer. A full schedule of dates and locations is now available at www.cmanet.org/AAPC-ICD10. The training is designed specifically for coding staff and intended to give attendees a comprehensive understanding of guidelines and conventions of ICD-10, as well as fundamental knowledge of how to decipher, understand and accurately apply codes in ICD-10. This American Academy of Professional Coders (AAPC) course is ... April 1, 2015 General Billing/Coding, ICD-10, Seminars, AAPC-ICD-10 0 0 Comment Read More »
Ask the Expert: Do I enter a qualifier in box 14 of the claim form if the patient has Medicare prime and a secondary insurance? Recently a number of practices have inquired as to whether Medicare requires the three-digit qualifier to be populated in item/box 14 when submitting a claim. Item/box 14, Date of Current Illness, Injury, or Pregnancy (LMP), identifies the first date of onset of illness, the actual date of injury, or the last menstrual period (LMP) for pregnancy, and contains a field allowing one of two qualifiers to be entered. 431: Onset of Current Symptoms or Illness 484: Last Menstrual Period The Medicare Claims Processing ... November 14, 2014 Medicare Medicare, Billing/Coding 0 0 Comment Read More »
Anthem to require NDC on claims for certain physician-administered drugs On September 30, Anthem Blue Cross notified physicians that effective January 1, 2015, it will require all professional providers to bill using the 11-digit National Drug Code (NDC) for drugs administered in a physician’s office. In the notice, Anthem says that currently, the lack of uniform coding system for drugs can result in inaccurate payments. The payor also states the change will allow it to be more consistent with Medicaid requirements and maintain consistent claims billing guidelines across all Anthem products. While the notice said the NDC would be required ... November 14, 2014 General Billing/Coding, Prescription Drugs, Anthem Blue Cross 0 0 Comment Read More »
How much revenue is your practice losing by not working denials? It’s no secret that claim rejections and denials can result in a significant amount of lost revenue. Consider this – a practice submitting 80 claims a day at an average reimbursement rate of $100 per claim should expect to receive $8,000 in daily revenue. If 10 percent of those claims were rejected or denied (eight claims per day at $100 per claim equals $800 per day), and the practice only appealed one out of every 10 rejections or denials ($720 per day loss), the practice could expect to lose ... October 10, 2014 General Denials, Insurance/Reimbursement, Practice Resources, Billing/Coding 0 0 Comment Read More »
Noridian denies 300,000 claims for E&M services in error Last fall, the Centers for Medicare and Medicaid Services experienced some editing issues with new patient evaluation and management (E&M) codes that resulted in incorrect claim denials. These issues began in October 2013, and were thought to have been corrected in late January 2014. The California Medical Association recently learned, however, that some claims continued to be denied incorrectly through July 15, 2014. In January, Noridian, California's Medicare contractor, began reprocessing claims that had been denied in error and correcting those subjected to overpayment recovery. Unfortunately, while implementing the corrections, ... September 4, 2014 Medi-Cal, Medicare Medicare, Noridian, Billing/Coding 0 0 Comment Read More »
Noridian incorrectly denies 300,000 claims for E&M services Last fall, the Centers for Medicare and Medicaid Services (CMS) experienced some editing issues with new patient E&M codes that resulted in incorrect claim denials. These problems started in October 2013, and was thought to have been corrected in late January 2014. The California Medical Association recently learned, however, that some claims continued to be paid incorrectly through July 15, 2014. Noridian, California's Medicare contractor, in January began making mass adjustments and correcting claims subjected to overpayment recovery. Unfortunately, while implementing the corrections, Noridian inadvertently subjected established patient E&M codes ... August 13, 2014 Medicare Medicare, Noridian, Billing/Coding 0 0 Comment Read More »
