May 17, 2012 Effective May 14, 2012, CMS has updated its enrollment process for Medicare providers. Providers and suppliers can now submit their enrollment applications 30 days sooner. CMS-855 enrollment applications and Internet-based PECOS applications may now be submitted 60 days prior to the effective date. This new policy does NOT apply to the following groups: 1. Providers and suppliers submitting a Form CMS-855A application 2. Ambulatory Surgical Centers (ASCs) ...

May 16, 2012 On May 9, 2012, a bipartisan bill was introduced to the U.S. House of Representatives that would permanently repeal the Sustainable Growth Rate (SGR) formula. The SGR formula was adopted by Congress in 1997 with the intention of preventing Medicare spending on physicians from exceeding the overall growth of the economy. Every year by March 1, the SGR is calculated and presented to the Medicare Payment Advisory ...

May 9, 2012 Today, May 9, 2012, the Department of Health and Human Services announced its proposed rule to implement the Affordable Care Act requirement that Medicaid reimburse primary care providers at the same as Medicare. As providers and their medical billing companies already know, Medicaid currently reimburses at a lower rate than Medicare in the majority of states, including Maryland. According to DHHS Secretary Sebelius, the proposed rule for ...

May 8, 2012 On April 24, 2012, Aetna updated Clinical Policy Bulletin (CPB) #0106 for fetal echocardiograms. If you render any maternal-fetal services, or likewise do the medical billing for any speciality that accepts commercial insurance, you should make yourself familiar with Aetna’s Clinical Policy Bulletins. These CPB’s clearly define Aetna’s standards regarding medical necessity and services that fall within the category of experimental and/or investigational billing. The CPB’s outline ...

April 26, 2012 Every provider and billing company knows that there will always be instances in which it is necessary to file a corrected claim. Perhaps a more appropriate CPT needs to be billed, a modifier appended, or diagnosis revised. In any case, the process of correcting and resubmitting claims can be both time-consuming and frustrating when reimbursement is delayed. If your medical billing team is still submitting corrected claims ...

April 19, 2012 The Centers for Medicaid & Medicare (CMS) recently released an MLN Matters Article that highlights the Medicare Secondary Payer (MSP) rules. These rules delineate the circumstances in which Medicare will only make payment after another insurance carrier issues the primary payment. All too frequently, physicians and their billing companies will receive denials from Medicare due to a coordination of benefits (COB) issue. As examples, Medicare will not make primary ...

April 19, 2012 According to Michigan State University, the occurrence of twin births has increased dramatically in the past several decades. Consider this remarkable statistic: in 1980, one in every 53 babies was a twin; in 2009, that number rose to one in every 30 births. These findings were presented in early April 2012 at the 14th Congress of the International Society for Twin Studies in Florence, Italy. Barbara Luke ...

April 09, 2012 In a press release issued today, HHS Secretary Kathleen Sebilius announced a proposed rule that will delay the compliance date for ICD-10 from October 1, 2013 to October 1, 2014. In February, the Secretary stated that the compliance date would be delayed; however, no firm date on the extension was provided until today’s announcement. This update provides valuable planning information for all HIPAA covered entities, from insurance ...