by k3llyadm1n | Dec 10, 2019 | Uncategorized
Physician Compare, a website that allows consumers to search and compare information about hundreds of thousands of physicians and other health care professionals, has been redesigned to make the site easier to use and provide new information for consumers. The Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner announced the redesign, which includes an improved search function and more frequently updated information.
“Nearly a million physicians and other health care professionals serve the Medicare population,” said CMS Administrator Marilyn Tavenner. “This vastly improved website will provide new information in an improved, easy-to-use format.”
Physician Compare was improved based on user and partner feedback, as part of improvements in the Affordable Care Act. The redesign includes new information on physicians, such as:
· Information about specialties offered by doctors and group practices;
· Whether a physician is using electronic health records;
· Board certification; and
· Affiliation with hospitals and other health care professionals.
Physician Compare is also now connected to the most consistently updated database so that consumers will find the most accurate and up-to-date information available. In 2014 quality data will be added, and this will help users choose a medical professional based on performance ratings.
Visit the Physician Compare website at http://www.medicare.gov/physiciancompare You can also go to www.medicare.gov and click on “Find doctors & other health professionals.”
A video highlighting the main features of the redesign is available at: http://www.youtube.com/user/CMSHHSgov
by k3llyadm1n | Dec 1, 2019 | Medicare
Part B Claims
Novitas Solutions Attn: Part B Claims PO Box XXXX (replace the Xs with the PO Box number from the table below) Mechanicsburg, PA 17055-XXXX (fill in the +4 from the table below)
| Part B Claims CMS 1500 Claim Form (08/05) |
PO Box |
Zip +4 |
| Arkansas |
P.O. Box 3098 |
17055-1816 |
| Colorado |
P.O. Box 3107 |
17055-1823 |
| DCMA |
P.O. Box 3396 |
17055-1841 |
| Delaware |
P.O. Box 3397 |
17055-1842 |
| Indian Health Services |
P.O. Box 3111 |
17055-1857 |
| Influenza/Flu Claims/Roster Billings |
P.O. Box 3112 |
17055-1827 |
| Louisiana |
P.O. Box 3097 |
17055-1815 |
| Maryland |
P.O. Box 3398 |
17055-1843 |
| Mississippi |
P.O. Box 3129 |
17055-1834 |
| New Jersey |
P.O. Box 3030 |
17055-1802 |
| New Mexico |
P.O. Box 3107 |
17055-1823 |
| Oklahoma |
P.O. Box 3107 |
17055-1823 |
| Pennsylvania |
P.O. Box 3418 |
17055-1854 |
| Texas |
P.O. Box 3108 |
17055-1824 |
by k3llyadm1n | Nov 28, 2019 | Commercial Insurances
Aug 16, 2013 Audiologist and Podiatrist Codes Updated
Horizon Blue Cross Blue Shield of New Jersey recently updated our claim processing system to ensure that benefits are being applied appropriately for certain services when performed by an audiologist or podiatrist.
The table below lists the CPT® and HCPCS codes that were updated in June 2013 to include the indicated specialty as “eligible” to provide that service.
| Specialty Type |
Code(s) |
| Audiologist* |
99201 99202 99211 99212 |
| Podiatrist |
L2820 |
If your office received claim denials for any date of service for the above-listed codes, you may request a claim adjustment.
- Call a Physician Services Representative at 1-800-624-1110, Monday through Friday, between 8 a.m. and 5 p.m., Eastern Time.
- Submit a copy of our Inquiry Request and Adjustment Form (579). This form is available within the Forms page of HorizonBlue.com.
If you have questions, please contact your Network Specialist.
* Please note that codes 99203-99205 and 99213-99215 are not eligible for reimbursement when performed by an audiologist.
CPT® is a registered trademark of the American Medical Association.
by k3llyadm1n | Nov 28, 2019 | Medicare
Update to Medicare Therapy Cap and Threshold 2013
January 1, 2013 through March 31, 2013
-Annual per beneficiary therapy cap amount is $1900 for physical therapy and speech language pathology services combined and there is a separate $1900 amount allotted for occupational therapy services.
-Providers may utilize the automatic process for exception for any diagnosis for which they can justify se…rvices exceeding the cap. Therapists may request an automatic exception for claims that are between $1900 and $3700 in expenditures. When the beneficiary qualifies for a therapy cap exception, the provider shall add a KX modifier to the therapy procedure code subject to the cap limits.
-Manual Medical reviews-completed on every claim at and after the beneficiary’s services exceed $3700.00
April 1, 2013 through December 31, 2013
-Annual per beneficiary therapy cap amount is $1900 for physical therapy and speech language pathology services combined and there is a separate $1900 amount allotted for occupational therapy services.
-Providers may utilize the automatic process for exception for any diagnosis for which they can justify services exceeding the cap. Therapists may request an automatic exception for claims that are between $1900 and $3700 in expenditures. When the beneficiary qualifies for a therapy cap exception, the provider shall add a KX modifier to the therapy procedure code subject to the cap limits.
-Recovery Auditors will conduct prepayment manual medical review in 11 demonstration states:
CA, FL, IL, LA, MI, MO, NC, NY, TX, OH, PA
-CMS will grant an exception to all claims with a KX modifier at and after the beneficiary’s services exceed $3700.00 and Recovery Auditors will conduct post payment review on all claims in the remaining states.
In the non-Demonstration states, the Recovery auditors will conduct immediate post-payment review. All claims will continue to go the MAC and once received the MAC will pay claim. The Recovery Auditor will then issue an Additional Documentation Request letter to the provider. The Recovery Auditor will complete manual medical review within 10 business days of receiving the additional documentation and will notify the MAC of the payment decision. If services are denied, the MAC will retract the payment.
by k3llyadm1n | Nov 27, 2019 | Coding Updates
2015 Modifier 59 -sub coding updates
The –59 modifier is the most widely used HCPCS modifier. Modifier -59 can be broadly applied. Some providers incorrectly consider it to be the “modifier to use to bypass (NCCI).” This modifier is associated with considerable abuse and high levels of manual audit activity; leading to reviews, appeals and even civil fraud and abuse cases.
The -59 modifier often overrides the edit in the exact circumstance for which CMS created it in the first place. CMS believes that more precise coding options coupled with increased education and selective editing is needed to reduce the errors associated with this overpayment.
The primary issue associated with the -59 modifier is that it is defined for use in a wide variety of circumstances, such as to identify:
vDifferent encounters;
vDifferent anatomic sites;
vDistinct services.
The -59 modifier is
- Infrequently (and usually correctly) used to identify a separate encounter;
- Less commonly (and less correctly) used to define a separate anatomic site;
- More commonly (and frequently incorrectly) used to define a distinct service.
CMS is establishing the following four new HCPCS modifiers (referred to collectively as -X{EPSU} modifiers) to define specific subsets of the -59 modifier:
XE- Separate Encounter, a service that is distinct because it occurred during a separate encounter.
XS –Separate Structure, a service that is distinct because it was performed on a separate Organ/Structure.
XP –Separate Practitioner, a service that is distinct because it was performed by a different practitioner.
XU- Unusual Non-Overlapping Service, the use of a service that is distinct because it does not overlap usual components of the main service.
CMS will continue to recognize the -59 modifier, but notes that Current Procedural Terminology (CPT) instructions state that the -59 modifier should not be used when a more descriptive modifier is available. While CMS will continue to recognize the -59 modifier in many instances, it may selectively require a more specific – X{EPSU} modifier for billing certain codes at high risk for incorrect billing.
As always, my staff will be available to assist you with any questions are concerns you may have.
