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1. Blue Cross Claims Paid at Wrong Rates;
Insurer Will Automatically Reprocess
CMA has learned that Blue Cross claims with early June dates of service were paid at the new Blue Cross fee schedule, even though implementation of the new fees was delayed until August 6.
The affected claims were paid prior to Blue Cross’s official decision to delay implementation of the fee schedule. Physicians do not need to appeal or resubmit these claims. Claims will automatically be readjudicated.
As previously reported, Blue Cross failed to provide physicians with timely access to the new fee schedule, leaving many physicians unable to assess the financial impact that the fee schedule changes would have on their practices.
The Department of Managed Health Care (DMHC), responding to complaints from hundreds of CMA physicians, forced Blue Cross to delay implementation of the fee schedule and take appropriate measures to notify doctors of the rate changes.
The new fee schedule has now been posted at the Blue Cross provider website.
Click here for more information, including a direct link to the fee schedule.
Contact: CMA’s Reimbursement Help Line, 888/401-5911 or jblack@cmanet.org.
2. CMS Launches Online PQRI “Measure Finder” Tool
This week, the Centers for Medicare & Medicaid Services (CMS) announced that physicians participating in the new Physician Quality Reporting Initiative (PQRI) can now quickly search for applicable measures and detailed specifications. The “Measure Finder” tool can be found on the PQRI tool kit page at the PQRI website. This tool will allow users to search for applicable measures based on a single code or a combination of codes.
The tool kit also contains educational resources and measure-specific worksheets designed to walk the user step by step through reporting for each measure.
PQRI is a voluntary reporting program that encourages quality improvement through the use of clinical performance measures. It establishes financial incentives – bonus payments of 1.5 percent of total allowed charges for covered Medicare physician services – for physicians who participate in this voluntary program. The current reporting period is for claims with dates of service from July 1 through December 31. Claims must be received on or before February 29, 2008, to be included in the bonus payment calculation.
Click here for more information.
Contact: Sandra Bressler, 415/882-5171 or sbressler@cmanet.org.
3. Medi-Cal Delays NPI Registration Deadline, Again
The California Department of Health Services (DHS) recently announced that Medi-Cal has extended its National Provider Identifier (NPI) registration deadline to November 25. Medi-Cal recently implemented a “dual use” period, during which physicians are encouraged to use both their Medi-Cal provider numbers and their NPIs (if available) on Medi-Cal claim forms. During this transition period, NPI use is encouraged but not required for adjudication. Physicians must, however, continue to use their Medi-Cal provider numbers until instructed otherwise.
This delay applies only to Medi-Cal and does not mean that physicians can put off applying for an NPI. As you know, the Centers for Medicare & Medicaid Services (CMS) recently announced a one-year grace period during which physicians will not be penalized for noncompliance as long as they have a contingency plan in place and are able to demonstrate “good faith efforts” to comply with the NPI regulations. However, to prove good faith, you must obtain your NPI as soon as possible. Since there are very few barriers to obtaining an NPI (it is a simple application), few physicians can argue that they need a contingency plan.
This delay does not affect paper claims. Effective this week, Medi-Cal will only accept the new universal claim forms (CMS 1500 for physicians, UB 04 for institutions). Claims submitted on old forms (HCFA 1500/UB 92) will be denied.
Physicians replacing multiple provider numbers (i.e. Medi-Cal and CHDP) with one NPI, should be aware that the “pay-to” address, EFT account, and PIN of the first legacy number entered during the Medi-cal NPI registration process will, by default, transfer to the new provider record.
Click here for more information.
Contact: CMA’s reimbursement help line, 888/401-5911.
4. Blue Shield Clarifies Payment Tiers for
Physical Medicine Multiple Services Policy
Blue Shield has posted details on its new multiple services payment policy on its secure provider website. The policy, which takes effect July 1, will in some circumstances reduce reimbursement for multiple procedures provided on the same day. (The CPT codes impacted by this new policy are 97001 to 97840.)
There will be three payment tiers (with the first tier being paid at 100 percent). The actual amount of the fee reductions for second and third tiers is available on Blue Shield’s secure provider website. To access information on the payment tiers:
- Log on to the secure provider website.
- Click on Announcements under News and Highlights.
- Select Physical Medicine Multiple Service Payment Policy Effective July 2007.
- Then click on Payment Policies and Rules and scroll down to Multiple Physical Medical Services Reduction.
CMA has also created a financial impact worksheet to help physicians assess the impact fee schedule changes will have on their practices based on their most commonly billed CPT codes.
Click here for more information.
Contact: CMA’s reimbursement help line, 888/401-5911 or jblack@cmanet.org.
5. CMA “Back to Basics” Seminar Series Trains Physician
Office Staff in Proper Billing and Collections Procedures
CMA’s Center for Economic Services is offering a series of “Back to Basics” seminars to train physician office personnel in proper billing and collections procedures. Whether you’re new to the field or just want a refresher course, this seminar will teach physicians and their office staff how to take greater control of the practice’s bottom line
The next seminars are July 11 and 12 in the Los Angeles area and July 18 in Orange County. If you are interested in attending a Back to Basics seminar in your area, contact your county medical society.
Click here for more information, including a list of all the currently scheduled seminars.
6. Old CMS-1500 Forms Will Not Be Accepted After July 1
Medicare carriers will stop accepting the old CMS-1500 forms on Monday, July 2. As reported earlier this year in CMA Alert, CMS announced it would continue accepting the old CMS-1500 claim forms past the original April 1 deadline because of formatting errors in some of the new forms being distributed by the Government Printing Office and other vendors. The form was updated to accommodate the mandated National Provider Identifiers (NPIs).
According to CMS, the problem is not as widespread as previously suspected. Please note that this issue involves the paper claim form only and does not affect the NPI implementation date. Medicare carriers can continue accepting legacy provider identification numbers until May 31, 2008.
Click here for more information
Contact: CMA’s reimbursement help line, 888/401-5911 or gfonseca@cmanet.org.
7. Member Benefit of the Week: Free Portfolio Review
CMA members get a free portfolio checkup — a $250 value — from CMA’s affinity partner, Mercer Advisors.
Mercer Advisors manages over $3 billion in assets, mostly for doctors. Mercer’s long-term investment strategy is firmly based on academic studies that identify the location of risk and return in capital markets.
Because Mercer Advisors is fee-based rather than commission-based, you can rest assured that its financial experts have your best interests at heart.
Members also get $500 off Mercer’s “Economic Freedom Program,” a comprehensive program that includes financial planning, investment management, and retirement and estate planning.
To schedule your free portfolio checkup, call 800/898-4642.
Click here for more information on your membership benefits.
Contact: CMA’s Member Service Center, 888/233-2937 or lgodward@cmanet.org.
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