Medical Billing

Beginning April of 2018, the Centers for Medicare & Medicaid Services (CMS) will begin replacing Medicare ID cards for 60 million Medicare beneficiaries. This is a fraud prevention initiative that removes Social Security numbers from Medicare cards to help combat identity theft and safeguard taxpayer dollars. Why are new Medicare ID cards important? Personal identity theft is impacting a large and growing number of senior citizens. Between 2012 and 2014 alone, incidents among seniors increased from 2.1 million to 2.6 million. Identity theft can take not only an emotional toll on those who experience it, but also a financial one: Two-thirds of all identity theft victims reported a direct financial loss. It can also disrupt lives, damage credit ratings and result in inaccuracies in medical records and costly false claims. Because of these issues, CMS has decided to take action to further protect seniors. What will be different? The new Medicare cards will use a unique and random ...

Medicare offers more health coverage choices and decreased premiums in 2018  According to CMS Medicare Advantage premiums decrease, choices increase, while enrollment hits an at all-time high Today, the Centers for Medicare & Medicaid Services (CMS) announced that people with Medicare will have more choices and options for their Medicare coverage in 2018. As CMS releases the benefit and premium information for Medicare health and drug plans for the 2018 calendar year, the average monthly premium for a Medicare Advantage plan will decrease while enrollment in Medicare Advantage is projected to reach a new all-time high. Earlier this year, CMS announced new policies that support increased benefit flexibilities allowing Medicare Advantage plans the ability to offer innovative plans that fit the needs of people with Medicare.   "More affordable choices lead to greater health security for those who need it most,” said Health and Human Services Secretary Tom Price...

Both Medicare beneficiaries and providers have certain rights and protections related to financial liability under the Fee-for-Service (FFS) Medicare and the Medicare Advantage (MA) Programs. These financial liability and appeal rights and protections are communicated to beneficiaries through notices given by providers: FFS Advance Beneficiary Notice of Noncoverage (FFS ABN) FFS Home Health Change of Care Notice (FFS HHCCN) FFS Skilled Nursing Facility Advance Beneficiary Notice (FFS SNFABN) and SNF Denial LettersFFS Hospital-Issued Notices of Noncoverage (FFS HINNs) FFS Expedited Determination Notices for Home Health Agencies, Skilled Nursing Facility, Hospice and Comprehensive Outpatient Rehabilitation Facility  (FFS Expedited Determination Notices) MA Denial Notices (MA Denial Notices) MA Expedited Determination Notices (MA Expedited Determination Notices) Important Message from Medicare (IM) and Detailed Notice of Discharge (DND) (Hospital Discharge Appe...

 the 2016 Physician Fee Schedule Final Rule, CMS updated the regulation text found at 42 CFR 414.904(j) to make clear that effective January 1, 2016, the payment amount for a biosimilar biological drug product is based on the average sales price of all NDCs assigned to the biosimilar biological products included within the same billing and payment code. In general, this means that CMS will group biosimilar products that rely on a common reference product’s biologics license application into the same payment calculation, and these products will share a common payment limit and HCPCS code. In order to provide CMS with the ability to track claims payment and to develop a better understanding of the use of specific biosimilar products in Medicare Part B, claims for separately paid biosimilar biological products will be required to include a modifier that identifies the manufacturer of the specific product. Modifiers will be used to distinguish between biosimilar products that ap...

Texas Top Claim Submission / Reason Code Errors - August 2017 # Explanation of Medicare Benefits Message Description Resolution 1 96 Non-covered charge. Prior to performing or billing a service, ensure that the service is covered under Medicare. Please refer to the Centers for Medicare & Medicaid Services Internet Only Manual, 100-02, Chapter 16. 2 109 Claim not covered by this payer/contractor. This denial indicates that the service is one that is processed or paid by another contractor. Examples of these types of service are: Durable Medical Equipment Hospice related services Medicare Advantage You must send the claim to the correct payer/contractor. 3 18 Duplicate claim/service. Please check claim status through the IVR to see if another claim was paid or is currently being processed. To prevent duplicate denials, allow us sufficient time to process a claim before submitting a second. 4 50 These are non-covered services because this is not deemed a 'm...

All of the BCBS plans have been posting announcements about the new alpha/numeric prefixes that they’re going to be rolling out next year. Below is the announcement that Anthem put in a recent newsletter: New member ID prefixes coming in 2018 The Blue Cross and Blue Shield Association (BCBSA) assigns member ID prefixes for all Blue Cross and Blue Shield branded Plans – Anthem Plans as well as non-Anthem Plans. There are a limited number of unused three-character, alpha only prefixes remaining, and they are expected to be exhausted in the 2nd or 3rd quarter of 2018. When that happens, the BCBSA will begin assigning prefixes that contain a combination of letters and numbers, or alpha-numeric prefixes. What does this mean to you? It will be even more important to ask your patients for their most recent identification (ID) card.When submitting claims, enter the identification number exactly as it appears on the member’s ID card.Check your EDI Software to make sure it ca...

G0296 counselling visit for lung cancer screening G0506 comprehensive assessment for CCM CPT code 90785 interactive complexity CPT code 90839 and 90840 psychotherapy for crisis CPT codes 96160 and 96161 patient focused health risk assessment

Next Generation Accountable Care Organization Model (NGACO Model) Overview: The Centers for Medicare & Medicaid Services (CMS) has launched a new accountable care organization (ACO) model called the Next Generation ACO Model (NGACO Model). The twenty-one ACOs participating in the NGACO Model in 2016 have significant experience coordinating care for populations of patients through initiatives, including, but not limited to, the Medicare Shared Savings Program and the Pioneer ACO Model. Building on experience from the Pioneer ACO Model and the Medicare Shared Savings Program, through this new model, CMS will partner with ACOs that are experienced in coordinating care for populations of patients and whose provider groups are ready to assume higher levels of financial risk and reward. This is in accordance with the Administration’s goal of tying 30 percent of traditional, or fee-for-service, Medicare payments to alternative payment models, such as ACOs, by the end of 2016 -- and...

Providers and suppliers must use the revised CMS-588 form (Electronic Funds Transfer Authorization Agreement) beginning January 1, 2018. The revised form will be posted on the CMS Forms List (https://go.usa.gov/xX3Sa) by early summer. Medicare Administrative Contractors will accept both the current and revised versions of the CMS-588 through December 31, 2017. Visit the Medicare Provider-Supplier Enrollment webpage for more information about Medicare enrollment and the Electronic Funds Transfer (EFT) requirements. Changes to the form include: New indicator shows if the EFT is for an individual or a group/organization/corporation in Parts 1 and 2 (Reason for Submission and Account Holder Information) Now optional to list the financial institution's contact person Four digits added to the "Provider's/Supplier's/Indirect Payment Procedure Entity's Account Number with Financial Institution," making it consistent with the industry standard

Are you aware there is a renewed version of the Advance Beneficiary Notice of Noncoverage (ABN) Form (CMS-R-131)? The new form was effective for use on or after June 21, 2017, and has an expiration date of March 2020. If you have not already done so, please begin using the new form

Medicare New Card with new ID, part of MACARA Initiative. Medicare will mail new Medicare cards between April 2018 and April 2019. Your new card will have a new Medicare number that’s unique to you, instead of your Social Security number. This will help to protect your identity. The new card won’t change your coverage or benefits. You don’t need to take any action to get your new Medicare card. Medicare will never contact you for your Medicare number or other personal information. Don’t share your Medicare number or other personal information with anyone who contacts you by phone, email, or by approaching you in person.