New Medicare Card Mailing Update – Wave 3 Begins, Wave 1 Ends New Medicare Card Mailing Update – Wave 3 Begins, Wave 1 Ends We started mailing new Medicare cards to people with Medicare who live in Wave 3 states: Arkansas, Illinois, Indiana, Iowa, Kansas, Minnesota, Nebraska, North Dakota, Oklahoma, South Dakota and Wisconsin. We continue to mail new cards to people who live in Wave 2 states and territories (Alaska, American Samoa, California, Guam, Hawaii, Northern Mariana Islands, Oregon), as well as nationwide to people who are new to Medicare. We finished mailing most cards to people with Medicare who live in Wave ... June 26, 2018 Medicare 0 0 Comment Read More »
Medi-Cal Update Several physicians report receipt of a notice from the California Department of Health Care Services (DHCS) regarding the decommissioning of their point of service (POS) device and request for its immediate return. This is another demonstration of DHCS’ desire to move claims processing, eligibility and the majority of interactions to be electronic-based. The Medi-Cal POS device is supplied to physician practices to verify recipient eligibility and clear share of cost liability. Per the notice, identified physicians have 30 days to return the device to DHCS from the date of ... June 19, 2018 Medi-Cal Medi-Cal, update 0 0 Comment Read More »
The Coding Corner: Reporting EM services with time as the controlling factor CPR’s “Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billing. This month’s tip comes from G. John Verhovshek, the managing editor for AAPC, a training and credentialing association for the business side of health care. Occasionally, a health care provider’s discussions with a patient about his or her medical condition(s) may consume a greater portion of the provider/patient encounter than the time devoted to performing a relevant history, exam and medical decision-making (MDM). In such cases, CPT® guidelines allow you to consider time as “the ... June 19, 2018 Coding coding, EM 0 0 Comment Read More »
UnitedHealthcare implements Smart Edits into the EDI claim process In the April 2018 UnitedHealthcare (UHC) network bulletin, UHC notified physicians that it would implement Smart Edits, a new functionality introduced into the EDI workflow, allowing the payor to autodetect claims with potential errors in the claims pre-adjudication phase. Once a potential error has been identified, UHC will notify the physician (via the 277CA report) within 24 hours, returning the claim to the provider along with a suggested modification to overcome the problem. Providers will have five calendar days to correct the claim and resubmit it, reducing the potential ... June 14, 2018 United Healthcare claims, edits, uhc 0 0 Comment Read More »
CMA urges Health Net to rescind recently announced payment policies Since Health Net first notified physicians in March of planned changes to its modifier 25 and emergency services payment policies for Medicare and Medi-Cal lines of business, the California Medical Association (CMA) has been working to educate the payor about physician concerns with the new policies. Last month, at CMA’s urging, Health Net agreed to delay implementation of the new policies until July 1, 2018, to allow time to review provider concerns with the new policies and to continue discussions with CMA and other stakeholders. CMA recently wrote to Health Net ... June 14, 2018 CMA, Health Net 0 0 Comment Read More »
