Utilize two timely claims filing extensions when CMS corrects an error or creates a retroactive entitlement benefit for a patient. CMS has revised its 12-month timely claims filing requirement (PBN 4/15/10). Transmittal 2140 carves out exceptions and provides additional information about the rule requiring you to submit a claim within 12-months from the date of service. A claim submitted more than 12 months after the date of service will be denied.

Most physicians and non-physician practitioners (NPPs) at your practice will be subject to “limited” screening when enrolling in the Medicare program. But CMS has lumped physical therapy providers and physical therapy groups into a category with more intense screening measures.

These charts offer a rare look at the success of appeals within Medicare Advantage (MA) plans, which do not often share their claims or appeals data with the public, unlike CMS. The first graph shows the percent of reconsiderations (second-level appeals) in which the MA plan’s decision was overturned (either partially or completely) or upheld (this also includes appeals that were dismissed). NOTE: All data comes from Maximus Federal Services Inc., a private contractor selected by CMS to act as the national independent review entity with oversight on MA denials. NOTE: Maximus only processes second-level appeals and does not have code-level data, a company official tells Part B News. The second graph shows the dollar amounts involved; all the data is from 2009.
 

We are a gastroenterology office and at times bill the tobacco cessation counseling visit code (99406). We don’t want to step on the primary care’s toes with respect to billing for tobacco counseling. Is it typically paid once per year for any physician? One time per patient, period?

A new CMS article explains how the agency’s auditors decide whether inpatient status was justified. CMS released the article as a response to provider concerns over how CMS, its carriers and various auditing groups utilize screening criteria to analyze documentation and make medical necessity determinations.

You and your peers can and should bill the new annual wellness visit (AWV) immediately, even when your carrier tells you to hold claims with the service, a CMS official tells Part B News. Some practices are reporting their carriers want them to hold claims with the AWV until April 2011. CMS says that goes against its policy.

You were first told by CMS that only providers themselves may register and attest for bonus payments under the Electronic Health Record (EHR) Incentive Program, using CMS’s new online website. This meant that third parties such as practice managers and office staff could not register as a “proxy” on behalf of providers, which would be a hassle for larger practices and groups (PBN 1/24/11).

You are less than 12 months away from a mandatory change to the 5010 HIPAA electronic transaction standard, and CMS’s plan to test 5010 transactions beginning April 1 is a chance for you to avoid any payment mishaps in 2012, experts say. Expect your vendors to be far enough along to be able to provide answers to your specific questions.