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CMS Delays Phase 2 for Claim Edits & Provides PECOS Help Line

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In early October, 2009 The Centers for Medicare & Medicaid Services (CMS) began Phase I to implement an expanded claim process to verify that the ordering/referring provider on a claim is eligible to order/refer and is enrolled in Medicare.  Phase 1 provides a warning edit. Phase 2 results in unpaid claims.  In both phases, they determine if the ordering/referring provider on the claim matches the providers in the national PECOS file: CEDI will verify the National Provider Identifier (NPI)…
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Medicaid Electronic Claims Required March 1

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According to a recent Medicaid ALERT to all providers, effective March 1, 2010, all Medicaid claims must be submitted electronically unless they require attachments or Administrative Review override by Medicaid.  Paper claims received after February 30 which do not require an attachment will not be processed by Medicaid. In addition, beginning March 1, calls to Medicaid’s Provider Assistance Center regarding patient eligibility will be directed to an electronic verification process or transferred to their Automated Voice Response System….
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Midmark ECG / MediSYS EHR Interface Operational

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MediSYS EHR Midmark Diagnostic Interface Birmingham, AL (January 15, 2010) – MediSYS Electronic Health Records integration of Midmark Corporation's IQ diagnostic products is now operational. The MediSYS EHR initial integration of Midmark's products includes IQMark Digital ECG and IQMark EZ Holter.  MIdmark, headquartered in Ohio, provides medical, dental and veterinary healthcare equipment solutions. MidMark's ECG and holter will connect seamlessly to MediSYS EHR for efficient clinical information flow.  In addition, greater efficiency is realized because the…
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CMS Proposed EHR Incentive Requirements

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On December 30, 2009, Centers for Medicare & Medicaid Services (CMS) published proposed requirements for the EHR Incentive Programs.  Their proposed rule would be used to implement the American Recovery and Reinvestment ACT of 2009.  There are two EHR incentive programs: Medicare and Medicaid.  The Medicare EHR incentive program pays incentives to eligible professionals for their meaningful use of a certified EHR.  The Medicaid EHR incentive program provides incentive payment to eligible professionals for implementing or upgrading…
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Medicare Crossover Process 15 days After Care Pays

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According to the Centers for Medicare and Medicaid Services (CMS), approximately 99% of all claims that Medicare identifies for crossover, as cited on provider Medicare Remittance Advice, are crossed over by CMS Coordination of Benefits Contractor (COBC).  The crossover failures are due HIPAA compliance issues or related data errors and the provider will receive a Medicare-generated special notification specifying the reason.  CMS is requesting that providers allow time for the Medicare Claim Crossover Process to process before attempting to balance bill…
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CMS Published Fact Sheet for PQRI / eRX Changes

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The Centers for Medicare and Medicaid Services (CMS) has indicated that the PQRI program in 2008 was a success with a significant increase in payments to eligible providers / professionals over 2007.  According to a news release from CMS dated Friday, November 13, more than 85,000 physicians and other eligible participants received incentive payments totaling more than $92 million.  As compared to the $36 million paid for 2007.  CMS published a fact sheet outlining the changes for the 2010…
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Blue Cross Blue Shield of Alabama Delays New Payment Methodology

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Blue Cross and Blue Shield of Alabama has announced that their new payment method that was scheduled to be implemented December 1, 2009 will be delayed.  They are expected to announce fee schedule and processing changes by July 1, 2010.  BCBS encourages providers to refer to https://www.bcbsal.org/providers/newpaymentmethodology/ or contact their Network Services Provider.  To view the carrier notification visit: https://www.bcbsal.org/providers/publications/providerFacts/2009-040.pdf  

Red Flag Rule Delayed

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On October 30, the Federal Trade Commission announced another delay in the enforcement of the "Red Flags" Rule.  At the request of Members of Congress, the "Red Flags" Rule, which was scheduled to go into action November 1, 2009, has been delayed until June 1, 2010.  For more information go to: http://ftc.gov/redflagsrule  

Phase I Underway: Editing the Ordering/Referring Provider in DMEPOS Claims

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Phase 1 of the DMEPOS Claims Edits is now underway.  Phase 1 will provide warning messages to prompt providers to take action prior to Phase 2 which will result in rejections beginning January 4, 2010.  Phase 1 (October 5, 2009 through January 3, 2010), DMEPOS suppliers who report ordering/referring providers who do not pass both edits will receive an informational message on their remittance. (Paper billers will not receive an informational message.) The claims will be paid. Phase 2 (January…
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Ordering/Referring Provider Case Sensitive Edits

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National Government Services, one of the largest Medicare contractors in the country, released the following information to avoid unnecessary claim rejections.  They will reject claims when lower case characters are submitted in the ordering/referring provider field.  See their notice below for details: Ordering/Referring Provider Case Sensitive Edits CEDI has front end edits in place to validate the data submitted conforms to HIPAA and Medicare requirements.  As part of these edits, the Common Electronic Data Interchange (CEDI) utilizes external code sources…
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3rd Annual Cardiovascular Update Conference

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MediSYS will be participating in the 3rd Annual Cardiovascular Update on November 7, 2009.  The 2009 Cardiovascular Update is being offered through The CVA Medical Education Foundation.  This continuing medical education meeting is designed to provide physicians and other healthcare staff with an overview of important developments in the care of patients with cardiovascular disease. The conference will be held in Birmingham at The Cahaba Grand Conference Center.  For more information or to register go to…
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