The Pulse

Knowledge is power. "The Pulse" is our way of keeping you informed of industry news, market trends and what's happening at IPMS. Stay informed so you can stay ahead. Check back often for updates!

ICD-10
Have you begun preparing for the successful implementation of ICD-10! The International Classification of Diseases 9th Revision currently contains about 17,000 diagnosis codes. The 10th revision – or “ICD-10” -- will increase that number to 155,000 and will prove to be the most challenging transition the industry has seen since the inception of coding.
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NGS System Merge
Connecticut's Medicare intermediary, National Government Services (NGS), is merging systems for their New York and Connecticut population. This consolidation will be taking place December 7, 2009 - December 23, 2009. During this transition period, NGS will not be processing claims. They will confirm receipt of claims submitted and hold until the system merge is complete. The expected completion date is December 23, 2009, to which all held claims will be forwarded to the MCS system for processing.

EDS Clinical and Surgical Pathology Services Payment Error
A November bulletin from Connecticut Department of Social Services was sent to notify Clinical and Surgical Pathology providers of an error in reimbursement rates posted with an effective date of 01/01/09 on the HTML and CSV versions of the Physician Office and Outpatient fee schedule.
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Will Your Medicare Payments be Impacted Beginning January 4, 2010?
During Phase 2 of the implementation of Change Requests 6417 and 6421 (January 4, 2010 and thereafter) if the item or service you bill requires an ordering/referring provider and the ordering/referring provider is not in the claim, the claim will not be paid. It will be rejected.
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Red Flags Rule Deadline Extended Again
The Federal Trade Commission (FTC), due to several requests from Congress, has extended the Red Flags Rule deadline for financial institutions and creditors, with "covered accounts", to develop and implement written identity theft prevention programs. These programs, per the FTC must "identify, detect, and respond to patterns, practices, or specific actions - known as "red flags" - that could indicate identity theft."
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RAC is back and here to stay!!:
What is RAC? Medicare's "Recovery Audit Contractors", a CMS initiative for auditing past claims. A three year RAC demo program identified and corrected more than 1.03 BILLION of improper Medicare payments. Based on the massive potential revealed through this demonstration process, the RAC audits are now permanent and effective in Connecticut as of July 1, 2009.
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Medicare Coinsurance and/or Deductible Claims Submission!!:
Currently, when a coinsurance and/or deductible claim does not automatically crossover to EDS electronically, providers have the option of submitting a paper claim with a legible copy of the EOMB attached. The information on the paper claim must be the same information submitted to Medicare and must mirror the EOMB exactly.
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Health Net - Medicare Advantage:
Health Net Medicare Advantage members' benefit for Part B prescription medications will change from no coinsurance required in 2006 to the standard Medicare benefit of 20 percent coinsurance. The 20 percent coinsurance applies to all Part B injectables and biologicals, including chemotherapy medications.

National Provider Identifier (NPI):
As many of you are aware, the Centers for Medicare and Medicaid Services (CMS) have implemented a new identifier for use in electronic health care transactions.
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New Provider ID Number for Blue Care Family Plan Claims
On July 1, 2006, as a result of an Anthem Blue Cross/Blue Shield system conversion, the Blue Care Family Plan (BCFP) claims processing system has been converted to a regional claims processing system called Anthem Consolidated East System (ACES).
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Connecticut Department of Social Services - Medicare Crossover Claims
Recently, there was a change in how EDS will receive Medicare crossover claims. The Centers for Medicare and Medicaid Services (CMS) has partnered with a Coordination of Benefits Contractor (COBC), Group Health Incorporated (GHI) to consolidate all Medicare claims processing.
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NCCI Edit Reversal Good News for Spine Surgeons!
Spine surgeons had been disappointed to read the April 2006 NCCI edit - Version 12.1 --- which bundled 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace, single interspace; lumbar) into 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar).
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