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ARCHIVES
July 2008
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News
Updates
Wed Jul 02, 2008
Holding Claims Paid Under the Medicare Physician Fee Schedule
CMS has requested the following information be furnished to providers of health care:
To the extent possible, CMS is working with Congress, health care providers and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, Non-Physician Practitioners (NPPs) and other providers of services paid under the Medicare Physician Fee Schedule (MPFS), beginning July 1, 2008. In this regard, CMS has instructed its contractors to hold these claims for the first 10 business days of July, for dates of service in July. This should have minimum impact on provider cash flow because, under current law, electronic claims are not paid any sooner than 14 days (29 days for paper claims) after the date of receipt. Meanwhile, all claims for services delivered on or before June 30, 2008, will be processed and paid under normal procedures.
After 10 business days, contractors will begin releasing claims to process under the fee schedule which implements current law. This, of course, could result in claims being processed with the negative 10.6 percent update. If a new law is enacted which changes the negative 10.6 percent update, retroactive to July 1, CMS is prepared to automatically reprocess most of those claims that have already processed.
Under the Medicare statute, Medicare pays the lower of submitted charges and the Medicare fee schedule amount. Claims with dates of service on or after July 1, 2008, billed with a submitted charge at least at the level of the January 1 – June 30, 2008, fee schedule will be automatically reprocessed, if Congress retroactively reinstates the update that was in effect for that time period. Any lesser amount will likely require providers to resubmit a revised claim.
To the extent possible, providers may hold claims in-house until it becomes clearer as to whether new legislation will be enacted or until cash flow becomes problematic. This will reduce the need for providers to reconcile two payments (i.e., the initial claim and the reprocessed claim), and it will simplify provider billings of beneficiary coinsurance and payment calculations for payers that are secondary to Medicare.
In addition, providers should be on the alert for more information about other legislative provisions that may affect Medicare Fee-for-Service (FFS) providers.
(CMS Joint Signature Memorandum (JSM) 08382, dated June 30, 2008, and CMS Contractor Provider Education Listserv (200806-24), dated June 30, 2008)
Posted on: Jul 02, 08 | 2:20 pm |
Thu Mar 20, 2008
Political Subdivision Workers Compensation Alliance
The PHO is finalizing contract discussions with the Political Subdivision Workers Compensation Alliance (the “Alliance”), a non profit organization which consists of five workers compensation risk pools providing workers compensation coverage for more than 500,000 public employees across Texas. Among those groups are the Texas Association of School Boards (TASB), Texas Municipal League (TML), Texas Association of Counties (TAC), The Texas Water Conservation Authority and the Texas Council (MHMR Centers).
The Alliance has already been implemented in many other areas of our state, and would like to expand into the Southeast Texas market. If you had previously notified the PHO that you are interested in receiving information about our workers’ compensation plans, you will be receiving an information and participation ballot packet soon. If you have questions or would like more information, please contact the PHO at 899-7791.
Posted on: Mar 20, 08 | 9:56 am |
Happy Doctor’s Day!
The First Doctor’s Day observance was March 30, 1933, in Winder, Georgia. The idea came from Eudora Brown Almond, the wife of Dr. Cha Almond, and the date was the anniversary of the first use of general anesthetic in surgery. On March 30, 1842, Dr. Crawford Long of Barrow County, Georgia used ether to remove a tumor from a patient’s neck.
Years later, the U.S. House of Representatives adopted a resolution commemorating Doctor’s Day on March 30, 1958. In 1990, legislation was introduced in the House and Senate to designate March 30th as National Doctor’s Day. The red carnation is the official flower of Doctor’s Day.
The CHRISUTS Southeast Texas PHO would like to wish all of our member physicians a “Happy Doctor’s Day” and extend our appreciation to your profession for your hard work and dedication to the Southeast Texas community.
Posted on: Mar 20, 08 | 9:56 am |
UniCare Lab Changes
Effective March 1, 2008, UniCare Health Plans of Texas (UniCare HMO/POS) will require utilization of Clinical Pathology Laboratories (CPL) for all HMO and POS members in Texas. Your office is asked to begin using CPL requisitions as of this date. Please call CPL with questions or to order forms at (713) 795-4299. If your office does not currently utilize CPL, you will be contacted and provided with the necessary information.
While there are currently no draw stations in the Golden Triangle, UniCare is working diligently to acquire them prior to the March 1, 2008 effective date. If you have questions or concerns about these changes, please contact UniCare Network Services at (888) 697-3790.
Posted on: Mar 20, 08 | 9:54 am |
Updated Work Comp Fee Guideline
The TDI-Division of Workers’ Compensation recently adopted a new medical fee guideline for work comp reimbursement in the State of Texas effective March 1, 2008. The new guidelines are posted at the agency website at: www.tdi.state.tx.us/wc/rules/adopted/adopted.html.
The new medical fee guideline establishes a new professional reimbursement rate of approximately 139% of Medicare for all services with the exception of Surgery performed in a facility setting, which is set at approximately 174% of Medicare.
Posted on: Mar 20, 08 | 9:54 am |
Get Ready for the NPI in 2008
Starting March 1, 2008, providers must use their National Provider Identifier (NPI) numbers in all paper-based and electronic Medicare claims. Legacy numbers may be included on claims as long as it is accompanied by an NPI number; however, after May 23, 2008, all transactions filed using legacy numbers will be rejected.
Providers should verify their data in the NPI Registry as soon as possible to avoid delays in the billing and credentialing processes. Providers should ensure that their correct primary practice location address is listed and that their name in the Registry matches the name printed on their license.
To search the NPI Registry, click on the following link: https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do.
Frequently Asked Questions on the NPI can be found here: http://www.cms.hhs.gov/NationalProvIdentStand/01_Overview.asp#TopOfPage.
Posted on: Mar 20, 08 | 9:53 am |
PHO Staff Promotions
We are happy to announce that Brooke Chodzinski was recently promoted to the position of Manager of Operations for the CHRISTUS Southeast Texas PHO. In this expanded role, Brooke is now responsible for the day-to-day operations of the PHO in addition to provider services, education, payor relations, and other management duties in the absence of the Executive Director.
In addition, Stephanie Benkert has been elevated to the Provider Services Coordinator position allowing her to expand her areas of responsibility to enhance the PHO’s provider service and payor relation activities to support our members.
Please contact the PHO if you are experiencing problems with contracting, claims payment or other issues we may assist you with. We are pleased to be able to continue offering you assistance and always striving to exceed your expectations and build relationships with our physicians, office staff and health plans. Together, we can make it happen!
Posted on: Mar 20, 08 | 9:52 am |
Manager of the Quarter- Spring, 2008
Congratulations to the PHO Manager of the Quarter – Amanda Snow, Officer Manager for Dr. Minda L. Toledo in Mid-County.
Amanda is originally from Beaumont and graduated from West Brook. She moved to the Nederland-Port Arthur area about three years ago. She is a kind, caring, reliable, honest and ambitious person. She works very hard to manage the ever growing patient load at Primary Care Pediatrics (PCP). She adores children and loves that she is able to work with them on a daily basis.
From all of us at the PHO, we congratulate Amanda for being nominated and selected as the “Manager of the Quarter”. We appreciate her dedication and contribution to the local community and healthcare industry. Keep up the great work!!
Do you have an outstanding Office, Billing or Front Desk Manager? Let us know! Each quarter, we will randomly draw a name from our submitted nominees to receive a special treat, courtesy of the PHO. The winner will be featured in the PHO newsletter and on our website as the “Manager of the Quarter”.
Posted on: Mar 20, 08 | 9:51 am |
Aetna Select Listing
Many of you may have recently received a Select provider listing from Aetna for commercial members for radiology, sleep studies, outpatient surgery, and dialysis services. Please make note that this is only a partial listing of network providers and that Aetna members will still receive full in-network benefits should they seek these services at other contracted providers such as CHRISTUS Hospital – St. Elizabeth, CHRISTUS Hospital – St. Mary, and CHRISTUS Jasper Memorial Hospital.
Posted on: Mar 20, 08 | 9:47 am |
Wed Mar 19, 2008
Reappointment Applications
If you received a recredentialing request from the PHO, please submit a completed Texas Standardized Credentialing Application which has been revised as of January 1, 2007. This new form, noted Revision 01/07 in the bottom left hand corner, is the only form accepted by our healthcare plans, the NCQA and per the TDI guidelines. Here is a link to the revised TSCA: http://www.tdi.state.tx.us/hmo/crform.html.
Posted on: Mar 19, 08 | 2:44 pm |
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