Medclaims
MEDICAL BILLING REPORTS
There are countless reports available to our clients, anytime they want them. At minimum, our clients receive Production and Aging Receivables reports. The Production report gives our clients a clear picture (in percentage and absolute numbers) of what was billed, adjusted and paid for any given period of time. The Aging report (which can be generated in many flavors such as by patients, locations, rendering physicians, insurance carriers, etc.) shows traditional outstanding balances by period of time, typically 30 days, 60 days, 90 days, 120 days.
EMR – ELECTRONIC MEDICAL RECORDS
Looking to interface your EMR system with a medical billing service? Look no further. We can accomplish this through established HL7 protocols. You can keep your existing EMR system while reaping the benefits of our proven services.
For more information, please contact us.
CLINICAL PSYCHOLOGISTS AND CLINICAL SOCIAL WORKERS
Clinical Psychologists and Clinical Social Workers
Reimbursements for all clinical psychologist (CP – specialty 68) services are based on the current year’s physician fee schedule payments. For the clinical social worker (CSW – specialty 80) services reimbursement amounts remain, as set by law, at 75 percent of the clinical psychologist reimbursement level.
CPT CODES 99201 THROUGH 99205
Background Information:
Palmetto GBA recently denied some claims for new patient office visits (CPT Codes 99201 through 99205) when they were performed by a physician assistant or a nurse practitioner with specialty codes 97, 89 and 42. We are correcting this situation and will perform a mass adjustment on the claims that were denied in the near future. There is no need to submit an appeal for these denials.
This affected claims starting with the following cycle dates for the areas indicated:
NCA/HI/NV: November 30, 2011
SCA: December 6, 2011
Applies To Procedure Codes:
99201
99202
99203
99204
99205
Remark/Reason Codes:
B16 ‘New Patient’ qualifications were not met.
MAC Action:
Palmetto GBA will reprocess these claims.
Provider Action:
None Required – Palmetto will mass adjust claims.
2012 ELECTRONIC PRESCRIBING (ERX) INCENTIVE PROGRAM
2012 Electronic Prescribing (eRx) Incentive Program Payment Adjustment Feedback Report Update
The Centers for Medicare & Medicaid Services would like to advise providers, due to the high volume of significant hardship exemption requests received, it is no longer technically feasible for CMS to provide a 2012 Electronic Prescribing (eRx) Incentive Program payment adjustment feedback report as originally intended. Please share with appropriate staff.
MEDICARE FEE-FOR-SERVICE (FFS) POLICY.
Medicare Fee-For-Service (FFS) Policy Regarding 90 Day Discretionary Enforcement Period for Non-Compliant HIPAA Covered Entities.
The Centers for Medicare & Medicaid Services (CMS) announced that it would not initiate enforcement action until April 1, 2012, with respect to any HIPAA covered entity that is not in compliance with the ASC X12 Version
5010 (Version 5010), NCPDP Telecom D.0 (NCPDP D.0) and NCPDP Medicaid Subrogation 3.0 (NCPDP 3.0) standards. Please share with appropriate staff.
ADDITIONAL WAY TO SUBMIT MEDICAL RECORD DOCUMENTATION
Additional Way to Submit Medical Record Documentation: Update
Effective January 15, 2012 Palmetto GBA providers will be able to submit medical records via esMD. In order to send medical documentation electronically to review contractors, Medicare providers, including physicians, hospitals, and suppliers, must obtain access to a CONNECT-compatible gateway. Be sure to share the tentative schedules for esMD services with appropriate staff.
CMS RELEASES IMPORTANT 5010 DEADLINE INFORMATION
CMS has released updated information regarding the 5010 transition. As stated in TDL-12148, Palmetto GBA will not reject compliant ASC X12 version
4010A1 transactions prior to April 1, 2012. The exact date and time 4010A1 transactions will be rejected will be published at a later date.
HIPAA 5010 COMPLIANT
Medclaims is HIPAA 5010 compliant with all trading partners!