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2014 PQRS Reporting: Avoid the 2% Penalty

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Eligible professional or group practices must satisfactorily report or satisfactorily participate submitting data on PQRS quality measures in 2014 to avoid the 2% payment adjustment will will be applied in 2016. The payment adjustment applies to covered professional services furnished by an eligible professional or group practice during 2016. Also, an additional 2% penalty will be applied to group practices of 10+ eligible professionals under the value-based payment modifier. This is again based on the…
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October 2014 – BCBS Discontinuing Paper Remittances

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 MediSYS Clients Submit More Electronic Claims to BCBS than any other vendor and clearinghouse. BCBS Discontinuing Paper Remittances Beginning October 1, ALL claims must be submitted electronically. BCBS will no longer accept paper primary, secondary and corrected professional and institutional claims. In addition, BCBS will discontinue mailing paper remittances for Alabama Providers starting October 2, 2014. If you have any questions regarding this new policy please contact BCBS EDI Services at 205-220-6899 or Ask-EDI@bcbsal.org. If…
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CMS Finalizes New Rule for 2014 CEHRT

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On August 29th, CMS released the final rule for providers who are unable to fully implement 2014 Edition CEHRT for an EHR reporting period in 2014 due to delays in 2014 CEHRT availability, to allow them to use the 2011 Edition of certified electronic health record technology (CEHRT) for calendar and fiscal year 2014. Providers may now use EHRs that have been certified under the 2011 Edition, a combination of the 2011 and 2014 Editions,…
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Keeping Collections Current

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Keeping Collections Current   Part 1: Keeping Collections Current Keeping collections current is vital to clinics in today’s medical industry. Managing the cash flow of your clinic can be an overwhelming and daunting task if you don’t have some procedures and office protocols in place to help keep cash flowing, bills paid, salaries met, and the like. Below is the first of several helpful ideas to keep your clinic maintaining a consistent cash flow and…
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BlueCare – New Health Advocacy Program for Members

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July 2014 BlueCare is the health advocacy program provided by Blue Cross and Blue Shield of Alabama that allows members to be informed and involved in their healthcare decisions. The program is designed to create a superior member experience, positively impact member health, and deliver predictable costs. BlueCare Health Advocates provide personalized one-on-one assistance to help Blue Cross members: Locate a doctor or specialist and schedule appointments. Understand their benefits. Resolve hospital and doctor/provider billing…
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Update on NCCI Edits from BCBS

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Update on NCCI Edits from BCBS July 2014 ProviderFacts 2014-023 announced that the modifier exclusion for the new NCCI edits that bundle CPT® consult codes 99241–99245 into spirometry CPT codes 94010 and 94060 would be removed effective May 1, 2014, in anticipation of the CMS changing the edit with the July 1, 2014, NCCI quarterly update. Recently, CMS made a decision to remove the January 1, 2014, edits that bundle consult codes into spirometry codes….
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MediSYS Provides Tools for Blue Advantage® (PPO) – New Claim Filing Requirement

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Update for 2016: Effective January 1, 2016, CPT code 83037 (Hemoglobin A1c Home Device) will also require a line item with the result using a CPT II procedure code. ———————————————————————————————————– BCBS of AL will begin implementing Blue Advantage claim filing requirements for chronic conditions to obtain complete and accurate medical data. BCBS will begin rejecting claims without this data October 1st , 2014. Please view – https://www.bcbsal.org/providers/publications/providerFacts/2014-035.pdf ———————————————————————————————————– BCBS Blue Advantage – To improve complete…
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MediSYS PM Releases Tools to Reduce Non-Specified Codes

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To assist practices with the Blue Cross Blue Shield of Alabama (BCBS) ‘Complete Picture of Health Documentation and Coding Improvement Initiative‘, MediSYS PM M2 has released new tools to help reduce the number of non-specific diagnosis codes. In addition, tools to more easily include co-existing, chronic conditions to consider including on the claim are also available. Major carriers including BCBS are encouraging providers to file up to 12 diagnosis codes using diagnosis codes that are…
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New Remittance Advice Codes for PQRS Claims-Based Reporting

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Below is an email notification from CMS regarding the new claims-based PQRS remittance codes effective July 1, 2014: Are you a PQRS eligible professional participating in claims-based reporting this year? Effective July 1, 2014, look for the updated Remittance Advice Remark Codes (RARCs) for PQRS claims-based reporting that went into effect on April 1, 2014. CMS has released a new FAQ with information about the updated codes. What are the New Codes and What Do They…
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Blue Cross Value Based Program June 30 Deadline PM Software Diagnosis Code Exercise

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Blue Cross 2014 Primary Care Value Based Program **June 30 Deadline PM Software Diagnosis Code Exercise** Blue Cross of Alabama’s 2014 Primary Care Value-Based Payment Program is based on three performance categories: Efficiency of Care, Administrative and Effectiveness of Care.  One element of the Administrative category is performing a Practice Management (PM) Software Diagnosis Code Exercise by June 30, 2014 per Tax ID. This exercise involves: Setting up test patient account(s) in PM as defined…
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Medicaid – Patient 1st Changes June 1, 2014

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Below is a notice of changes made to Patient 1st program effective June 1st.  Providers treating or referring patients enrolled in Patient 1st must fax a Group/Clinic Patient 1st Update Form to Medicaid Provider Enrollment at 334-215-4298.  Claims will deny if providers are not enrolled.   Change to use of Group NPI and Non-enrolled Physicians in Patient 1st Program April 29, 2014 TO:     All Physicians and Enrolled Patient 1st Providers   The Alabama Medicaid Agency made…
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Medicaid Correction to CO for EOB Codes (3323, 3324)

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***IMPORTANT UPDATE for Medicaid EOB Codes (3323, 3324)*** From November 22, 2013 until May 20th, 2014 the new EOB codes 3323 & 3324 were being electronically submitted by Medicaid to providers in the electronic remittance file as the adjustment code: CO45 in error which automatically adjusted-off the rejected claim. On May 20th, for the June 6, 2014 check write, Medicaid corrected the issue and began sending CO4 (the procedure code is inconsistent with the modifier…
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