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 »
How to file effective second bill reviews for workers' compensation This is the second in a two-part series focusing on coding, compliance and documentation issues relating specifically to Workers’ Compensation billing. This month’s tip comes from Catherine Montgomery, the founder and CEO of DaisyBill, which offers software solutions for workers’ compensation medical billing. Previously discussed was the importance of filing second bill reviews (SBR) for workers’ compensation medical bills, even if the underpayment is small. In the increasingly unforgiving workers’ comp billing environment , it is incumbent upon providers to make sure that billing staff or third-party billers correctly submit ... August 8, 2014 General Practice Resources, Workers Compensation, Coding and Documentation 0 0 Comment Read More »
