Public Payer News

Please select the links below for complete Medicare/Medicaid articles and events of the current year. Scroll down for resource links.

02.10.12 Free diabetes course available for 200 seniors in Atlanta

The Medicare Diabetes Screening Project (MDSP) is collaborating with the YMCA Diabetes Prevention Program (YDPP) to provide scholarships for adults 65 and older in the Atlanta area who have blood glucose levels in the pre-diabetic range (via FPG, OGTT, or A1C testing) to attend a 16-week lifestyle change course.

The scholarship recipients will be able to attend the course, which normally costs $325. The scholarships are being given on a first-come, first-served basis, and patients must be enrolled in Medicare and be diagnosed with pre-diabetes and be overweight to qualify.

Physicians are encouraged to have applicable patients contact Linda Vaughn with the Metro Atlanta YMCA at 404.527.7690 or preventdiabetes@ymcaatlanta.org to apply for a scholarship. Seniors who have Medicare who have at least one risk factor can be screened for diabetes on an annual basis with no co-pay and/or deductible.

click here for additional information

02.10.12 Electronic Data Interchange department publishing top claim rejections for December for HIPAA 5010

Click here for Medicare Part A rejections

Click here for Medicare Part B rejections

02.08.12 Physician self-referral Prohibition: Additional information on exception process for physician-owned hospitals

As a reminder, the Outpatient Prospective Payment System (OPPS) Final Rule that was released on Wed Nov 30, 2011, stated that, in order for a physician-owned hospital to receive an exception to the prohibition on facility expansion, it must satisfy eligibility criteria to qualify as an "Applicable Hospital" or "High Medicaid Facility." Questions regarding this issue can be emailed to POHexceptions@cms.hhs.gov.

Click here for additional gudiance

02.08.12 Medicare overpayments and offset request

Did you know that you can submit an immediate offset request when you receive an overpayment demand letter? It is simple and there are advantages to requesting an immediate offset. They are:

  • Avoiding the possibility of checks crossing in the mail and subsequent duplicate collection
  • Cost savings associated with check fees and postage
  • Minimize or avoid interest due to late receipts

Click here to complete the overpayment offset request form

02.07.12 CMS releases ordering/referring physician documentation responsibility

Click here for article

02.07.12 CMS releases Part B appeals process webinar recording

Click here to access the webinar recording
Click here for the handouts

02.07.12 Cahaba GBA plans ICD-10 webinar on February 15

Cahaba GBA invites you to attend a Medicare Part B ICD-10 webinar - ICD-10: "The Next Generation of Coding" - on February 15 at 2 p.m. ET. The webinar is targeted for new office staff members, residents, new physicians, and seasoned providers of the Medicare Part B program.

Click here for additional details and/or registration information

02.06.12 Only one electronic remittance advice recipient per NPI/Legacy ID beginning April 1

Prior to the implementation of HIGLAS (the Healthcare Integrated General Ledger Accounting System), Medicare’s Multi-Carrier System (MCS) created just one check per sender, National Provider Identifier (NPI), or legacy ID. Each sender/NPI/legacy ID was able to have multiple receivers of the electronic remittance; MCS would use the sender ID submitting each claim to aid in determining to whom the remit should be sent. For each check that was created, MCS also created an electronic remittance advice (ERA), which accurately reported the payment amount for that ERA.

When a MAC transitions to HIGLAS, only one check can be produced per NPI/legacy ID. In order to accurately produce electronic remittance advices to match the EFT/check amount, MCS will be changing their logic effective Sunday, April 1, 2012 – and will no longer consider the sender information when creating the ERA files. MACs will allow only one receiver of an electronic remittance per NPI/legacy ID regardless of whether the provider submits their inbound files under different sender IDs. Your respective MAC will be contacting you if you are set up on their files for multiple receivers of the ERA, in which case you will need to select one receiver for your electronic remittance.

02.06.12 Recovery Audit Contractor (RAC) demands letters tips and reminders for Part B providers

With the implementation of Change Request (CR) 7436, responsibility for the issuance of Recovery Audit Contractor (RAC) demand letters was shifted to the Medicare Administrative Contractors (MACs) effective January 1, 2012. Connolly Healthcare, the RAC for J10 and Mississippi Part B providers, will continue to submit claims adjustments to Cahaba Government Benefit Administrators®, LLC (Cahaba GBA). Cahaba GBA will process the adjustments based upon the review conducted by Connolly Healthcare and issue an automated demand letter.

The demand letters are generated based on an automated system setup by CMS which creates letter address information for your practice or office that was obtained from your provider enrollment data. This address is defined as the “Special Payment” address (e.g., remittance notices, special payments) in Section 4B on your Provider/Supplier Enrollment application, CMS Form-855B. Providers may choose to update their address information via the CMS Form-855B. Please note this change would impact other demand letter correspondence (non-RAC) that is also generated from the “Special Payment” address.

Connolly Healthcare continues to be responsible for communicating to providers the rationale for claim adjustments initiated by their office. Connolly Healthcare also will continue sending letters to providers with this information and is responsible for responding to providers regarding the rationale for the claim adjustments.

Providers may visit the Connolly Healthcare RAC website at www.connollyhealthcare.com/RAC to review the rationale for RAC transactions. To access the Provider Portal Login, enter the state abbreviation, Medicare provider number and the total charge amount listed for the appropriate ICN.

Contact information for Connolly Healthcare is provided below:
Connolly Healthcare RAC Office
The Navy Yard Corporate Center
One Crescent Drive, Suite 300-A
Philadelphia, PA 19112
Toll-free phone number: 866.360.2507; Fax number: 203.529.2995

Read the CMS MLN Matters article

01.25.12 Cahaba GBA posts recording of 'Medicare 101: An Overview of Medicare Part B'

Click here to access the webinar recording

01.24.12 CMS Website addresses EHR incentives attestation appeals process

The Centers for Medicare and Medicaid Services (CMS) has updated the "Attestation Section" of its Medicare and Medicaid EHR Incentive Programs Website to include information addressing the appeals process. CMS began accepting appeals for eligible professionals on December 1. Call 855.796.1515 (between 9 a.m. and 5 p.m. Monday through Friday) or e-mail OCSQAppeals@provider-resources.com or visit www.cms.gov/EHRIncentivePrograms for additional information.

01.24.12 PC-ACE Pro32 Version 2.34 now available for Part A and Part B providers

Click here to download

01.24.12 Cahaba holding 'Medicare 101' course on February 1

Cahaba GBA would like to invite you to attend a Medicare Part B Appeals webinar on "Medicare 101: The basics on the Part B appeals process" that is targeted to office staff members, residents and physicians new to the Medicare Part B program. It will be held on Wednesday, February 1 at 2 p.m.

Click here to register

01.13.12 Electronic Data Interchange department publishing top claim rejections for HIPAA 5010

Click here for Medicare Part A rejections
Click here for Medicare Part B rejections

01.12.12 CMS holding provider call on January 25 on Medicare FFS implementation of HIPAA Version 5010 and D.0 transaction standards

The Centers for Medicare and Medicaid Services (CMS) is holding a national provider call on 'Medicare FFS Implementation of HIPAA Version 5010 and D.0 Transactions' on Wednesday, January 25 from 2 p.m. to 3:30 p.m. ET.

Click here for more details, including instructions on how to register for the call

01.11.12 CMS recruiting reviewers for Health Care Innovation Challenge

The Centers for Medicare & Medicaid Services (CMS) is recruiting "reviewers" for the applications that are submitted in concert with its new Health Care Innovation Challenge, which will "fund up to $1 billion in cooperative agreements to support a broad spectrum of alternative models of health care payment, delivery, and workforce utilization that deliver better health care, better health, and lower cost for beneficiaries of Medicare, Medicaid, and the Children’s Health Insurance Program." Candidates should send their full name, phone number, organization, email address, and how they heard about the opportunity to CMMI@grantreview.org by January 31. The review process will begin in February. Reviewers must participate in a two-hour training session. CMS is "offering an honorarium of $500 to non-Federal employees who fully participate through the entire process."

Click here for additional information on the Health Care Innovation Challenge

01.10.12 New CMS FAQ resource addresses Medicaid RAC program

The Centers for Medicare and Medicaid Services (CMS) recently unveiled an FAQ resource that addresses the Medicaid Recovery Audit Contractor (RAC) program, which was expanded by the Patient Protection and Affordable Care Act.

Click here for the Medicaid RAC FAQ summary
Click here for a summary of the final Medicaid RAC rule

01.10.12 Cahaba says practices can resubmit December 23 "BHT" rejections

Cahaba GBA says that Medicare Part B providers that submitted a claim in the 4010A1 format on December 23, 2011 and received a "BHT CREATE DATE GREATER THAN CURRENT DATE" rejection message can resubmit any rejected claims. Cahaba GBA is also stressing that the "issue did not affect 5010 claim files." Call EDI Services at 866.582.3253 with questions.

01.06.12 'Medicare 101: An Overview of Medicare Part B' Webinar to be held on January 11

Cahaba GBA would like to invite new physicians, residents, and new office/billing personnel to attend a Medicare Part B overview webinar on January 11 at 2 p.m. Designed for the beginner, this presentation will be very broad in nature.

Click here to register

01.06.12 PC-ACE Pro32 Version 2.32 file upgrade now in effect

Details for Part A users
Details for Part B users

12.20.11 CMS flagging common Medicare FFS submissions errors

Click here for news from CMS

12.13.11 CMS Version 5010 troubleshooting presentation available online

The Centers for Medicare and Medicaid Services (CMS) recently released a "HIPAA Version 5010: Twenty First National Provider Call: Troubleshooting" slide presentation, which addresses key claims and operational issues. It also includes Medicare Administrative Contractor contacts information.

Click here for CMS Version 5010 troubleshooting presentation

12.07.11 Cahaba GBA posts recording of HIPPA 5010 implementation call

Cahaba GBA held a conference call for physicians and other stakeholders on December 1 that addressed the December 31 HIPPA 5010 compliance deadline.

Click here for a recording of the call

12.05.11 $1 billion program to fund grants for innovations in payment, delivery

The Center for Medicare and Medicaid Innovation (CMMI) is promoting the $1 billion "Health Care Innovation Challenge," which will provide grants of $1 million to $30 million for projects that develop new payment and delivery models to improve medical care outcomes for Medicare, Medicaid and Children's Health Insurance Program beneficiaries. The grants will be paid over a three-year period and a wide range of organizations may apply -- including physician and other provider groups. Applicants must present a plan for long-term sustainability (e.g., a partnership with other stakeholders like a private payer or local employer). Applicants must submit a letter of intent by December 19 and file the full electronic application by January 27. Awards will be made on March 30. CMMI says there will be a second round of awards in August 2012, though it hasn’t announced the application deadlines for the second round.

Click here for details from CMMI

12.05.11 CMS reminds physicians that National Influenza Vaccination Week is December 4-10

Click here to read more from CMS

11.29.11 CMS redacts NPIs from Medicare revalidation list

The Centers for Medicare and Medicaid Services (CMS) says that it revised the list of providers who have been contacted to revalidate their Medicare enrollment that it recently published by redacting the providers’ National Provider Identifier number (NPI) to protect them from identity theft. CMS says the list now only shows the last four digits of the NPI. CMS is encouraging physicians to check the list to determine if they received a revalidation notice in the mail from their Medicare Administrative Contractor (MAC). While CMS has extended the Medicare revalidation effort through 2015, it stresses that physicians who are asked to revalidate must do so within 60 days or risk deactivation. CMS says the first group of providers who were contacted for revalidation were those who are not yet in the CMS Medicare Provider Enrollment, Chain, and Ownership System (PECOS).

Go to https://www.cms.gov/medicareprovidersupenroll/11_revalidations.asp and click on “Revalidation Phase 1 Listing” for the list of providers who have been contacted to revalidate their Medicare program participation.

Click here for an article on the revalidation effort

11.22.11 CMS says providers must use new ABN forms no later than January 1

The Centers for Medicare and Medicaid Services (CMS) is stressing that providers must begin using the 2011 version of the Advance Beneficiary Notice of Noncoverage (ABN) form (CMS-R-131) beginning on January 1, 2012. CMS extended a September 1 deadline through the end of the year. The ABN form is used by all providers, practitioners, and suppliers who are paid under Medicare Part B – as well as hospice providers and religious non-medical health care institutions (RNHCIs) who are paid under Medicare Part A on an exclusive basis. CMS says that any old/2008 ABN forms that are submitted after January 1 will be considered invalid by Medicare contractors.

Go to the “FFS Revised ABN” link on www.CMS.gov/BNI to obtain the 2011 form

11.18.11 Georgia organization awarded funds to find new ways to improve care for people with Medicare

Read press release from CMS

11.18.11 CMS announces 90-day grace period for Version 5010 compliance

The Centers for Medicare & Medicaid Services (CMS) has announced that it will not "initiate enforcement action until March 31, 2012, with respect to any HIPAA covered entity that is not in compliance with the Version 5010 HIPAA transactions." But CMS is also stressing that it will "accept and investigate complaints of non-compliance with the Version 5010 transactions as of January 1." Physicians that have a complaint filed against them will have to provide evidence of compliance or a good faith effort to become compliant during the 90-day grace period, according to CMS.

MAG is encouraging physicians to work with applicable software vendors, billing services, clearinghouses, and payers to ensure that they will be Version 5010 compliant to avoid claims rejections and interruptions in cash flow.

Go to the "Resources" section of the Medicare/Medicaid key issues page on www.mag.org for additional information on Version 5010.

11.16.11 Medicare Shared Savings/ACO application now online

The Centers for Medicare and Medicaid Services (CMS) has posted the application for the 2012 Medicare Shared Savings/Accountable Care Organization (ACO) program on its Website. The 21-page application can "be submitted between December 1 and January 20 for participation beginning April 1, 2012 and (the application can be submitted) between March 1 through March 30 for participation beginning July 1, 2012."

Click here for the Medicare Shared Savings/ACO application

11.16.11 Version 5010 requires street address or physical location

All physicians and other health care providers who submit electronic claims must comply with Health Insurance Portability and Accountability Act (HIPAA) Version 5010 standards beginning January 1, 2012. Among a number of changes, the Version 5010 standard requires physicians to use a street address or physical location as the billing provider address. Practices that wish to continue to have payments sent to a P.O. or lock box will have to report this information in the “pay-to” address field. Physicians are being encouraged to work with their practice management system vendor, billing service, or clearinghouse to effect this change to prevent claims rejections or interruptions in cash flow.

Click here for additional information on the Version 5010 standards

11.11.11 MAG members invited to Cahaba GBA's jurisdiction wide meeting on December 6 in Atlanta

Click here for details

11.08.11 MAG prepares resources on Medicare/Medicaid audits, including recovery audit contractors (RACs)

During the past few years, the Centers for Medicare and Medicaid Services (CMS) have broadened their efforts in identifying errors that are made in payments to physicians commonly referred to as fraud and abuse or "program integrity programs." This MAG-prepared educational chart is designed to provide a quick reference guide to physicians on the principal entities who are most directly involved in various aspects of claims adjudication and audit activities with physicians. There is also a chart that outlines each entity by name, legislative authority, the review process, and actions which physicians may take to address their findings, especially (Fee-For-Service) physicians.

Click here for MAG introduction on the audits
Click here for 'Physician Medicare/Medicaid Audits' chart
Review OIG's physician compliance plan
OIG's 2012 workplan
CMS statement of work for the Recovery Audit Program

11.04.11 Automate your claims process -- cut costs and hassles

Download free electronic claims submission and status toolkits from the American Medical Association (AMA) now!

Submitting claims can be costly and time-consuming, and often, it doesn't end there. Keeping track of outstanding claims can cause even more headaches. Keep your claims process running smoothly with the "Claims and claim status transactions: The advantages of going electronic" webinar and its related toolkits.

Automating your process of submitting and determining the status of your claims can:

  • Decrease claims submission and tracking costs by five percent to 90 percent
  • Send claims to payers in real time, expediting response and boosting cash flow
  • Save time and money by cutting back on time spent calling health insurers
  • Diminish claim rejections and simplify claims processing
  • Free up time for revenue-enhancing functions, such as ensuring correct payment

Click here for updates
Click here to sign the AMA's "Heal that Claim" pledge

11.02.11 Medicare revalidation reportedly delayed until end of 2015

The Centers for Medicare & Medicaid Services (CMS) has announced that it will delay the requirement for providers and suppliers who were enrolled in Medicare before March 25, 2011 to revalidate their enrollment in Medicare until the end of 2015, according to the American Medical Association. CMS originally announced that Medicare Administrative Contractors (MACs) would send revalidation notices to providers and suppliers before March 2013. CMS also has reportedly said that it will enhance the Medicare Provider Enrollment, Chain, and Ownership (PECOS) system in a number of ways by the end of 2012 in order to make revalidation less onerous for physicians. Among the improvements CMS says it has planned are e-signatures, electronic document uploads, batch upload capabilities, and seamless password resets.

10.31.11 DCH, HP to host Medicaid Fair in Macon on November 16

The Georgia Department of Community Health (DCH) and HP Enterprise Services is encouraging physicians and other health care provider stakeholders to attend a Georgia Medicaid Fair at the Centreplex in Macon on Wednesday, November 16 from 7 a.m. to 6 p.m. The opening session will focus on the 5010 and ICD-10 initiatives. The event will feature a number of break-out sessions on topics like crossover claims, durable medical equipment, the Peach State Health Plan, WellCare of Georgia, physician services, and Web Portal Training. A number of DCH business partners will be on hand for the event. DCH staff members will also be available to address the Medicaid Electronic Health Records (EHR) Incentive Payment Program and the DCH Health Information Technology (HIT) program. Go to www.hp.com/go/GPW2011 to register and for logistical details. DCH is stressing that attendees must register for the individual sessions online in advance. Attendees will be able to sign-in for the event as early as 7 a.m. on November 16, while the first session will begin at 8:30 a.m. DCH says that attendees must bring a copy of the confirmation e-mail that they receive from DCH to get into the event. Contact HP Enterprise Services at 678.713.3699 or at georgiamedicaidfair@hp.com for additional information.

10.31.11 CMS promoting eRx program hardship request help desk

Click here for details

10.31.11 Register for CMS' final 2011 'ACO Accelerated Development Learning Session' on November 17-18 in Baltimore

Click here for details

10.27.11 HHS-OIG releases 2012 work plan for combating Medicare fraud

Click here for details

10.27.11 CMS hosting ACO meeting/call in Atlanta on November 21

The Centers for Medicare and Medicaid Services (CMS) is hosting a meeting to discuss the final rule for the Medicare Accountable Care Organization (ACO) program that includes “new incentives for providers” that will take place from 1 p.m. to 2 p.m. on Monday, November 21. CMS says the meeting is intended to “(help providers) understand what CMS wants to achieve through the various ACO models.” The meeting will feature Jonathan Blum, who is the CMS deputy administrator and the director of the Center for Medicare, and Richard Wild, M.D., who is the Chief Medical Officer for CMS in Atlanta. CMS says participants are welcome to attend the meeting in person or participate by teleconference on a “listen only” basis. The event will take place at the Tom Harkin Global Communications Center at the Centers for Disease Control & Prevention, which is located at 1600 Clifton Road in Atlanta. To participate by phone, dial 877.267.1577 and use meeting ID number 4494. Questions can be submitted in advance to teresa.wilson@cms.hhs.gov by November 15.

10.24.11 CMS' frequently asked questions on bundled payments for Care Improvement Initiative

Click here for details

10.19.11 CMS to host call on Medicare enrollment/revalidation on October 27

The Centers for Medicare and Medicaid Services (CMS) will host a call for providers to address the Medicare provider enrollment/revalidation process on Thursday, October 27 from 12:30 p.m. to 2 p.m. CMS says that most providers will have to revalidate their Medicare enrollment given the new risk screening criteria that is required by Section 6401(a) of the Patient Protection and Affordable Care Act. The deadline to register for the call is 12 p.m. on Thursday, October 27, or once the call has reached capacity. CMS says it will post an audio recording and transcript on that Website following the call.

Click here to register or for additional information

10.19.11 CMS flagging 2012 eRx program changes

The Centers for Medicare and Medicaid Services (CMS) is stressing that beginning January 1, 2012, eligible professionals who haven’t met the requirements of the eRx incentive program who do not qualify for a hardship exemption will be subject to a payment adjustment. CMS says the “adjustment will reduce Medicare payment rates by one percent of the provider’s allowable Medicare Part B charges in 2012.” The deadline for requesting a hardship exemption is November 1.

Click here for additional information

10.12.11 CMS issues consumer warning on Pre-Existing Condition Insurance Plan Website

The Centers for Medicare and Medicaid Services (CMS) issued the following consumer alert on October 9, 2011: "The CMS has recently become aware of a website that has the appearance of being an official government website for the Pre-Existing Condition Insurance Plan. This new website - http://preexistingconditioninsuranceplan.com - is not maintained by any government programs and consumers are strongly urged not to submit any personal information requested by this website under the assumption that it is a government website. CMS is taking the appropriate steps to protect consumers from being misled. The Pre-Existing Condition Insurance Plan made available through the Affordable Care Act makes health insurance available to people who have had a problem getting insurance due to a pre-existing condition. The Pre-Existing Condition Insurance Plan: covers a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs; does not charge you a higher premium just because of your medical condition; does not base eligibility on income. Individuals interested in this new federally backed program should visit: www.pcip.gov or call 866-717-5826."

10.04.11 CMS finalizes changes for 2011 Medicare eRx incentive program

The Centers for Medicare & Medicaid Services (CMS) has announced changes to the Medicare Electronic Prescribing (eRx) Incentive Program for the 2011 program year.

Click here for a quick reference guide on the Medicare eRx program

09.23.11 New CMS guide addresses program integrity contractors

The Centers for Medicare & Medicaid Services (CMS) recently published the Contractor Entities At A Glance: Who May Contact You About Specific CMS Activities guide to raise awareness about the entities that are involved in claims adjudication. The new resource includes a chart that provides details on each entity by type. Note that Medicare Recovery Audit Contractors (RACs) are referred to as "Fee-For-Service (FFS) Recovery Auditors" in the documents.

Click here for the Contractor Entities At A Glance: Who May Contact You About Specific CMS Activities guide
Review MAG's TPP department chart on RACs in Georgia
Click here for a related article

09.20.11 CMS issues final rule for Medicaid RACs

The Centers for Medicare & Medicaid Services (CMS) recently released the final rule for Medicaid Recovery Audit Contractors (RACs). CMS says the implementation deadline is January 1, 2012.

Click here to see the final rule for Medicaid RACs

09.20.11 CMS Medicare enrollment revalidation process underway

The Centers for Medicare & Medicaid Services (CMS) has announced that it will require all providers and suppliers who were enrolled in Medicare prior to March 25, 2011 to revalidate their enrollment in the program. In an e-mail to providers, CMS said that Medicare Administrative Contractors (MACs) will send revalidation notices to individual providers and suppliers between August 10, 2011 and March 2013. CMS has stressed that providers cannot begin the revalidation process before they receive the notice from a MAC. CMS says that providers will have 60 days to submit the enrollment form once they receive the notice from a MAC. Failure to submit the enrollment form could result in “deactivation of Medicare billing privileges,” according to CMS.

Click here for additional information from CMS

09.19.11 Cahaba GBA posts 'HIPAA 5010 is fast approaching' webinar for Part A/B providers

Click here to watch recording

09.19.11 Government agencies join together for public-private partnership with 'Million Hearts'

Learn more about the national effort to prevent one million heart attacks and strokes

09.12.11 Top 5 reasons for Medicare claims rejections in August

View PDF

09.07.11 DCH hosting focus groups for Medicaid & PeachCare redesign

As part of its effort to redesign the Medicaid and PeachCare for Kids programs, the Georgia Department of Community Health (DCH) is conducting focus groups in the state that will include a variety of stakeholders -- including physicians and other providers, consumers, advocacy groups and vendors. Go to www.research.net/s/DCHFFocusGroupApplication to register for one of the focus groups. Go to www.dch.georgia.gov to see a DCH press release on the redesign initiative.The registration deadline is Tuesday, September 16.

09.01.11 CMS extending e-prescribing exemption until November 1

Click here for details

09.01.11 AMA addresses proposed Medicare payment rule for 2012 in letter to CMS

Click here for AMA letter to CMS

08.30.11 PC-ACE Pro32(tm) Version 2.30 now available for users

Click here to download the new release

08.30.11 CMS promoting fraud prevention toolkit

The Centers for Medicare & Medicaid Services (CMS) is promoting the availability of the CMS Fraud Prevention Toolkit to help prevent and fight fraud, waste and abuse. CMS says that it is moving from a "pay and chase" recovery operations model to a "prevention and detection" model. CMS says it now "has the ability to use risk scoring techniques to flag high risk claims and providers for additional review and take action to stop payments and remove providers from the program when necessary."

Go to www.cms.gov or call 800.621.8335 to obtain the CMS Fraud Prevention Toolkit

08.26.11 Medicaid CMOs could go statewide in 2012

The Amerigroup and Centene Medicaid care management organizations in Georgia could be expanded to the entire state under a contract amendment that is under consideration, according to Georgia Department of Community Health Medicaid Chief Jerry Dubberly, Pharm.D. He stresses that the amendment has not yet been executed or approved by the Centers for Medicare and Medicaid Services. Assuming the deal goes forward, Dubberly says the expansions would not take place until January 1, 2012. Dubberly told MAG that the change would not increase the managed care populations in the state, though he said it would give members a greater choice of plans within each region.

08.17.11 CMS says national Version 5010 testing week to begin August 22

The Centers for Medicare & Medicaid Services (CMS) and the Medicare Fee-for-Service (FFS) Program will hold a national Version 5010 testing week beginning Monday, August 22. Version 5010 is related to HIPAA transaction standards. CMS says physicians - including their clearinghouse and/or billing service - will have the opportunity to test the Version 5010 transactions with "real-time help desk support and direct and immediate access to the Medicare Administrative Contractors (MACs)." CMS is encouraging physicians to work with their MAC to ensure they comply with Version 5010.

Click here for additional information

08.16.11 An update on the ICD-10 remediation project

Click here for details from Georgia DCH

08.16.11 Georgia Medicaid electronic health record technology incentive payment program details

Click here for details from Georgia DCH

08.08.11 CMS holding provider call on August 18 on Medicare/Medicaid EHR Incentive Program meaningful use requirements

Click here for additional information (Must register by 1:30 p.m. on August 17)

08.08.11 MAG president urges support for the Medicare Patient Empowerment Act (S. 1042)

Read Dr. DeLoach's letter to Sen. Johnny Isakson

08.05.11 AMA to hold CPT Changes 2012 and ICD-10-CM workshops in Atlanta on December 8 & 9

Click here for details on the CPT Changes 2012 workshop
Click here for details on the ICD-10-CM workshop

07.21.11 HP Enterprise Solutions releases message about new GHP Web Portal for Georgia Medicaid

Click here for troubleshooting document from HP

07.21.11 New resource designed to help physicians prepare for payer audits, patient inquiries

The American Medical Association (AMA) has introduced the AMA PATH Practice Analysis Tools for Healthcare - a "powerful benchmarking data and financial analysis tool that helps physicians develop effective and defensible fee schedules, and coding and billing analysis safeguards, while maximizing revenues." AMA says physicians can use the new online resource to prepare for payer audits, adding that the AMA PATH resource shows physicians how their procedure and modifier utilization profiles compare with other physicians by practice and specialty. AMA is also pointing out that patients will have access to a new "medical cost look-up" database that was created by FAIR Health, an independent non-for-profit organization, beginning in August. AMA says patients will consequently be able to determine the average charge for a particular medical service in their region. AMA is, therefore, suggesting that physicians be prepared to address questions related to patient charges. Health insurers are also expected to use the database to determine reimbursement rates for out-of-network charges, according to AMA. AMA says physicians can use its PATH resource to "set a solid fee schedule that accurately reflects your cost of doing business and the value of the services you provide."

Click here to purchase the AMA PATH and for additional information

07.15.11 CMS hosting national ICD-10 call for physicians August 3

The Centers for Medicare & Medicaid Services (CMS) will host a national provider call on "ICD-10 Implementation Strategies for Physicians" on Wednesday, August 3 from 1 p.m. to 3 p.m. EST. CMS representatives will discuss ways that physicians can prepare for the change to ICD-10 for medical diagnosis and inpatient procedure coding. The call will include an ICD-10 overview, as well as an update on claims spanning the implementation date, national ICD-10 implementation issues, and laboratory conversion process. The call will end with a Q&A session. The call is open to physicians, medical coders, office staff, billing staff, and health records staff. Registration is available on a first-come, first-served basis – and registration will close at 2 p.m. on August 2.

Click here to register for the August 3 call

07.15.11 CMS says national Version 5010 testing week to begin August 22

The Centers for Medicare & Medicaid Services (CMS) and the Medicare Fee-for-Service (FFS) Program will hold a national Version 5010 testing week beginning Monday, August 22. Version 5010 is related to HIPAA transaction standards. CMS says physicians – including their clearinghouse and/or billing service – will have the opportunity to test the Version 5010 transactions with “real-time help desk support and direct and immediate access to the Medicare Administrative Contractors (MACs).” CMS is encouraging physicians to work with their MAC to ensure they comply with Version 5010.

Click here for additional information

07.13.11 Cahaba GBA to hold provider call on troubleshooting during the ICD-10/Version 5010 transition on July 20

Cahaba GBA will hold a webinar on Wednesday, July 20 from 1 p.m. to 3 p.m. EST that covers the latest news and information for Part A and Part B providers and trading partners as they prepare for the ICD-10/Version 5010 transition. Cahaba says that the Electronic Data Interchange department will discuss specific troubleshooting topics related to the 5010 transition. The event also will reveal common issues identified during 5010 testing. Space is limited and the registration deadline is July 15.

Click here to register for the July 20 Webinar

07.13.11 AMA offers new toolkit to help prepare for Jan. 1 HIPAA compliance

Are you on track to meet the Jan. 1, 2012 compliance deadline for using Version 5010 of the HIPAA electronic standard transactions? If you or your vendor submit claims electronically, you must comply with this deadline. Physician practices who aren't prepared risk rejected claims and cash flow interruptions.

Click here to access the AMA's toolkit

07.13.11 Top 5 Reasons for Claims Rejections in June

View PDF

07.12.11 AMA releases its '2011 National Health Insurer Report Card'

Click here to read the full report

06.29.11 New podcasts available from the national provider call on "Preparing for ICD-10 Implementation in 2011"

The Centers for Medicare & Medicaid Services (CMS) has created four new podcasts from the audio of the January national provider call on "Preparing for ICD-10 Implementation in 2011."

Click here to download the podcasts

06.10.11 Electronic claims to require a street address starting Jan. 1, 2012

Starting Jan. 1, 2012, physicians must report either a street address or a physical location in the billing provider address field in order to comply with the HIPAA 5010 version of the electronic standard transactions.

Click here for details

06.06.11 Top 5 Reasons for Claims Rejections in May

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06.02.11 CMS to hold national 5010 testing day on June 15

The Centers for Medicare & Medicaid Services (CMS) will hold a national 5010 testing day on Wednesday, June 15 from 9 a.m. to 4 p.m. CMS is encouraging Medicare Fee-for-Service (FFS) trading partners to test their ability to meet technical compliance and performance processing standards.

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03.18.11 New Medicare Part B provider orientation Webinar recording

Are you new to the Medicare Part B program? If so, take a moment to listen to the "New Provider Orientation" webinar recording. The event highlights basic Medicare information, self-service tools and other helpful resource information.

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03.18.11 Top 5 Reasons for Claims Rejections in February

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02.21.11 Top 5 Reasons for Claims Rejections in January

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02.07.11 Georgia Better Health Care member exclusion change for children under age 19

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01.06.11 Medicare sets physician payment rates for 2011

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01.01.11 Office of Inspector General increases auditing efforts, resource can help physician practices prepare

In September 2010, the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services published its 2011 Work Plan, which became effective on Oct. 1, 2010. The Work Plan describes the areas in which the OIG will focus specific audit, investigation, enforcement and compliance activities. The OIG indicated that it will review the extent of potentially inappropriate payments for evaluation and management (E&M) services. The OIG stated that Medicare contractors have noted an increased frequency of medical records with identical documentation across services.

The AMA's new Practice Analysis Tools for Healthcare (AMA PATH™) can help physicians analyze their individual coding and billing practices and compare them with national averages by specialty. Using AMA PATH, a physician can analyze his or her billing patterns with respect to individual E&M codes and, in so doing, enable the physician to identify and rectify any billing or coding practices or patterns that might draw the attention of the OIG or other governmental agencies.

View the OIG's work plan
Learn more about AMA's online tool

01.01.11 CMS issues reminder on January 2011 target for testing transaction standards; 2013 compliance date for ICD-10 code sets

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01.01.11 AMA's 'How you can prepare now for ICD-10'

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01.01.11 Cahaba GBA closing Savannah office by April 2013

Read letter from Cahaba GBA

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