HOMEABOUT
USEXECUTIVE
TEAMPRESS
RELEASESNEWSLETTERCONTACT
US |
||||
| HOMEABOUT
USEXECUTIVE
TEAMPRESS
RELEASESNEWSLETTERCONTACT
US |
 |
|
||||
|
|
Return to newsletter archives | View the current newsletter NEWSLETTER - JULY 2006Reimbursement and Compliance Update: July 2006Trauma AlertThe Central Office on ICD-9CM is the highest authority for diagnostic coding. In their first quarter 2006 publication, instructions were published regarding how to code for an indication of trauma. They state that 'trauma' by itself is not always indicative of an actual injury. If findings are negative, and no signs or symptoms are given, the coder is instructed to code as V71.4, Observation following other accident. Unfortunately, many payers consider this a non-payable code. Consistent With ReminderThe AHA ICD-9 Coding Clinic states that the term "consistent with" fits the definition of a probable or suspected condition. Please be aware that any condition preceded by this wording should not be used for coding and billing purposes. It is imperative that when possible, the patient is asked for body site-specific symptoms and that this information be included in the dictation.If there are no other findings to code for, we will code from the reason for the test and/or the history. Dictating PainBoth the ACR and the Office of ICD-9 are in agreement that coders can infer the site of pain when the radiologist dictates "pain" without a specific site mentioned, and there is only one body site imaged. If you are interpreting images from multiple body sites on the same report, and the patient has pain, you must specifically state where the sites of pain are. A generic mention of pain for these multiple body site reports is not codable as anything other than generalized pain, which is often considered non-payable. Draft Medicare PoliciesTexas and Virginia have two draft policies available for comment and review.
MRI Joint Medicare Carrier Websites
Missouri Medicaid Now Requiring Pre-AuthorizationsThe Division of Medical Services announced today that Missouri Medicaid will implement a preauthorization requirement for certain radiology procedures performed in freestanding facilities and hospital outpatient departments. This does not affect inpatient or emergency department services. Effective July 17, 2006, the following procedures will require preauthorization:
The information published by Medicaid suggests that more procedures will be added to the preauthorization list in the future. Missouri Medicaid is also implementing a new electronic tool, CyberAccess, which will automate the process. To become a CyberAccess user, contact the ACS Heritage help desk at 888-581-9797 or 573-632-9797, or send an email to MoMedCyberaccess@heritage-info.com. The CyberAccess tool allows each prior authorization to automatically reference the individual recipient's claim history, including ICD-9 diagnosis codes and CPT procedure codes. Requests for prior authorization will also be taken by the Pharmacy Exceptions Hotline at 800-392-8030 option 2. 9 Day Payment Hold on Medicare PaymentsA brief hold will be placed on Medicare payments for all claims during the last 9 days of the Federal fiscal year (September 22 through September 30, 2006). These payment delays are mandated by section 5203 of the Deficit Reduction Act of 2005. No interest will be accrued and no late penalties will be paid to an entity or individual by reason of this one-time hold on payments. All claims held during this time will be paid on October 2, 2006. This policy only applies to claims subject to payment. It does not apply to full denials, no-pay claims, and other non-claim payments such as periodic interim payments, home health requests for anticipated payments, and cost report settlements. Please note that payments will not be staggered and no advance payments will be allowed during this 9-day hold. MRA Run-off Dictation RequirementsAn MRA run-off is normally coded as an MRA of the abdomen and one or both extremities. The AMA and ACR have agreed that the MRA abdomen should capture the aorta, at a minimum, from the level of the renals to the bifurcation. Please remember to mention these areas when dictating these procedures. Not mentioned equals not done, and not reimbursed for. Fee Schedule Changes for Missouri BluesAnthem Blue Cross and Blue Shield, formerly doing business as Blue Cross Blue Shield of Missouri, has announced changes to its PPO fee schedule. Office E&M codes will be increased. Some will be effective 7-1-06 and some 10-1-06 Injectables will be reimbursed at Average Sales Price plus 11%, effective 10-1-06 Radiology codes will see a substantial decrease, with some decreasing up to 58%. If you have questions concerning these changes, or would like to voice your concerns, the Network Specialists are listed below. We have been told that these regional assignments will be changing, but the changes are not yet published.
Visit Our WebsitePlease visit us at www.evolutions-mbs.com where you can find information on the services we provide, our performance metrics, and staff biographies. Take a look and see what Evolutions can do for your practice. If you would prefer to receive this newsletter via e-mail please send your e-mail address to: bkirchhoff@evolutions-mbs.com If you have questions concerning this information, please contact:
If you would like to talk with us about what Evolutions can do for your practice, please contact:
Home | About Us | Executive Team | Press Releases | Newsletter | Contact Us | Practices Served | Services Offered | Technology Solutions | Performance Metrics | Practice Reviews Copyright © 2006 Evolutions. All rights reserved.
|
|
||
