Medical Briefs
CMS Eliminates the Use of Consultation
Codes for Medicare Patients
In an effort to clarify how commercial payers will
address the use of consult codes starting in January 2010, Cathy
Weaver inquired with the following payers: Cigna, Sagamore, Aetna, Aetna
Work Comp, Anthem (Indiana), United (Midwest) and Medical Mutual of Ohio.
All noted that they will continue to accept and reimburse for Consult Codes
with their covered lives. The only exceptions are the Medicare plans
provided by these payers. All Medicare plans offered through commercial
payers will abide by Medicare billing rules. This presents some challenges
for your practice in assuring the appropriate codes are billed for your
Medicare patients. As well use of Consult Codes where Medicare may be a
secondary crossover claim will certainly be an area for you to monitor and
to determine the best process for your practice. As we receive updated
information from commercial payers, we will pass it along. For details on
the CMS final rule, see
article by Joy Newby, LPN, CPC, PCS of Newby Consulting, Inc.
Also, see Becker's Orthopedic & Spine Review article, "14 Points About the
End of Consultation Codes and Onset of Lower Reimbursements for Orthopedic
Surgeons and Other Specialists"
online.
PECOS - The Centers for Medicare & Medicaid Services (CMS) will delay, until April 5, 2010, the implementation of Phase 2 of Change Request (CR) 6417 (Expansion of the Current Scope of Editing for Ordering/Referring Providers for Claims Processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs)) and CR 6421 (Expansion of the Current Scope of Editing for Ordering/Referring Providers for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Supplier Claims Processed by Durable Medical Equipment Medicare Administrative Contractors (DME MACs)). CRs 6417 and 6421 are applicable to Part B claims only. Full release...
Medical School Debt - A full 87% of students graduating from American medical schools in 2008 carried outstanding loans. Their educational debt averaged $154,607, 11% more than the debt carried by 2007 graduates, according to data published by the Association of American Medical Colleges.
Cost of Health Insurance Rises - Premiums for employer-sponsored health insurance stood at $13,375 annually for family coverage in 2009, an increase of 5% over 2008. On average, employers paid $9,860 of the total premium cost. Figures are from the 2009 Employer Health Benefits Survey (Kaiser Family Foundation and the Health Research & Educational Trust).
Health Care Commentaries is
provided by Somerset’s
Health Care Team
for our clients and other interested persons upon request. Since
technical information is presented in generalized fashion, no final
conclusion on these topics should be made without further review. For
additional information on the issues discussed, please contact a member
of our Health Care Team. This
document is not intended or written to be used, and cannot be used, for
the purpose of avoiding tax penalties that may be imposed on the
taxpayer.
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