Industry News

On Aug. 22, the AMA sent letters of support to the sponsors of House and Senate legislation that would rescind the multiple payment reduction policy applying to the professional component of certain services.

After vetoing legislation last year, California Gov. Jerry Brown signed a bill over the weekend that requires women in the state to be notified following a mammogram if they have dense breast tissue.

Physicians now have an extra year to prepare for the new ICD-10 code set as the result of a final rule issued Aug. 24 by CMS. The rule delays the compliance deadline by one year to Oct. 1, 2014.

Faced with a proposed 27 percent cut to Medicare fee-for-service rates come Jan. 1, per the 2013 Medicare Physician Fee Schedule (MPFS) proposed rule, physicians have been waiting for a sign indicating Congress will override the Sustainable Growth Rate (SGR) methodology that calls for the cut, as they have since 2003. Rep.

CMS is issuing this article as an important reminder and the article reflects no change in current Medicare policy.

Health and Human Services (HHS) Secretary Kathleen Sebelius announced today the release of a new rule that will cut red tape for doctors, hospitals, and health plans. In combination with a previously issued regulation, the rule will save up to $9 billion over the next ten years.

If you have applied for a Z-Code Identifier or have switched your PTI for a Z-Code Identifier, you may submit a coverage determination request online.

This exciting new feature provides the following benefits:

* Employs standardized, time-bound technical assessment (TA) application

Beginning August 13, 2012, CGS will send all overpayment letters (demand letters) in light blue envelopes. Requests for repayment of Medicare funds are time-sensitive, and they hope that this change in envelope color will help you quickly and easily identify these requests.

Providers are incorrectly coding claims when billing for multiple specimens of CPT code 88305. Multiple specimens for the same date of service, billed on the same claim, should be submitted on one detail line by adjusting the ìnumber billed fieldî to reflect the number of specimens. Billing these services on separate details is inappropriate.

Effective for dates of service on or after September 1, 2012, medical policy for breast cancer susceptibility gene 1 and gene 2 (BRCA1/BRCA2) analyses have been updated. This laboratory test is billed using HCPCS Level II code S3820 (complete BRCA1 and BRCA2 gene sequence analysis for susceptibility to breast and ovarian cancer).

Effective September 1, 2012, the MO HealthNet Division will begin covering the multigene expression assay procedure called Oncotype DX Breast Cancer Assay. This assay predicts outcomes for patients with early stage estrogen receptor (ER)-positive, lymph node-negative breast cancer by examining the tumor at a molecular level.

New York State Medicaid is working to increase provider compliance with delay reason reporting on claims aged more than 90 days. New edits will verify the validity of Delay Reason Codes reported on the claim.

The newly released CARC and RARC codes reflects the Remittance Advice Remark Code that BCBS should be using when they are denying a claim under the BlueCard program that was not submitted to the plan whose service area the specimen was collected.

New RARCs

Youíll find the latest information about procedure codes and Blue Cross Blue Shield of Michigan billing guidelines in the following chart. Procedures for which BCBS MI is clarifying their guidelines will appear under Policy Clarifications.

POLICY CLARIFICATION

S3870

Experimental

81228, 81229