PA House Wants Time Limits for Retroactive Denials to Providers!!

Give them some applause - contact your legislators if you're in the state of PA. Pennsylvania House pursues time limits on denial of reimbursement cases NAIC NewsWire | 01/21/2009 State legislators want a bill limiting retroactive reimbursement denials from health insurers to Pennsylvania's medical providers. Currently, carriers can take several years to review reimbursement records, but lawmakers would like to cut the time to one year except in cases of fraud, duplicate claims submissions and coding mistakes. See the full story here:

PECOS Online Enrollment

I attended the CMS Enrollment department Open Door Forum on PECOS on line Enrollment that is being made available to practices. This functionallity is quite exciting. Instead of having to navigate through the long paper 855 forms, PECOS is a guided enrollment, where it asks you questions as to what you are trying to do and then you are lead just to the areas you need to fill in for your enrollment needs. There is no guessing as to what you need and it will make sure your enrollment is complete, no enrollments will go in incomplete through PECOS internet enrollment.

OIG Reviews Pinnacle Business Solutions, Inc. for 2005

Review of High-Dollar Payments for Medicare Outpatient Services Processed by Pinnacle Business Solutions, Inc., During Calendar Year 2005 (A-06-08-00042) http://www.oig.hhs.gov/oas/reports/region6/60800042.pdf None of the four payments of $50,000 or more that Pinnacle made to providers for outpatient services during calendar year 2005 were appropriate. Three of the claims were adjusted prior to the start of our audit; for the remaining claim, Pinnacle overpaid the provider $46,000.

Anesthesia Billing

I'm new to anesthesia billing and am having trouble. How do I show an accurate charge amount if only the time units/minutes (and not the base units) are to be noted in box 24G of the CMS 1500? Also, Medicare requires submission of anesthesia minutes instead of units...how does that work?

BCBS to Cut up to 1,000 Jobs

LANSING, Mich.: The state's battered economy took another blow Friday when Blue Cross Blue Shield of Michigan announced plans to eliminate up to 1,000 jobs this year and request rate increases for some of its health insurance customers. The Detroit-based nonprofit said the moves are necessary to preserve its financial health. Read the rest of this story here: http://www.iht.com/articles/ap/2009/01/16/america/Blue-Cross-Job-Cuts.php

CMS - E-Prescribing Incentive Program Update

E-Prescribing Incentive Program Update

Medicare Fee Schedules

The Centers for Medicare & Medicaid Services (CMS) has condensed all 56 Physician Fee Schedule (PFS) carrier specific pricing files into one zip file. This file is found in the list on the CMS web page at http://www.cms.hhs.gov/PhysicianFeeSched/PFSCSF/list.asp. It is labeled as “All States” in the State field, and “2009” in the Calendar Year field. Because the list is ordered by State name, “All States” appears after the Alaska files. If you sort by most recent Calendar Year, the file will appear at the top of the list.