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For services provided on and after October 1, 2015, U.S.-based entities covered under the Health Insurance Portability and Accountability Act (HIPAA) are required to use ICD-10 code sets. ICD-9 codes will no longer be accepted on claims for services provided on or after October 1, 2015. ICD-10 consists of two parts: ICD-10-CM diagnosis coding which is for use in all U.S. health care settings. ICD-10-PCS inpatient procedure coding which is for use in U.S. hospital settings.   Medscape recently reported that nearly a quarter of physician practices say they will not be ready for the ICD-10 implementation deadline on October 1, 2015, while another 25 percent say they are unsure whether they’ll be ready. The latest Workgroup for Electronic Data Interchange […]

For services provided on and after October 1, 2015, U.S.-based entities covered under the Health Insurance Portability and Accountability Act (HIPAA) are required to use ICD-10 code sets. ICD-9 codes will no longer be accepted on claims for services provided on or after October 1, 2015. FACT: ICD-10 will have a substantial impact on you and your practice. Medicare fee-for-service end-to-end testing in January/February and in April/May showed claims acceptance rates of only 81% and 88% respectively. The results of end-to-end testing conducted in July have not yet been released by CMS. Beginning October 1, 2015, you should be prepared for the possibility of your claims being rejected by your Medicare Administrative Contractor and by private insurance carriers; thus, you should prepare for substantial delays […]

General Overview of the Proposed 2016 Physician Fee Schedule The Social Security Act (the Act) requires the Centers for Medicare & Medicaid Services (CMS) to establish payments under the Physician Fee Schedule (PFS) based on national uniform relative value units (RVUs) that account for the relative resources used in providing a service. The Act requires that RVUs be established for three categories of resources: work, practice expense and malpractice expense. The Act also requires CMS to establish by regulation each year’s payment amounts for all physicians’ services paid under the PFS, incorporating geographic adjustments to reflect the variations in the costs of furnishing services in different geographic areas. There are over 1 million physicians, other practitioners, and medical suppliers that […]