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August 5, 2015
Published by Liz Vogt at August 5, 2015
Categories
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 […]
August 5, 2015
Published by Liz Vogt at August 5, 2015
Categories
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 […]
June 22, 2015
Published by Liz Vogt at June 22, 2015
Categories
On April 1, 2015, Wisconsin Physicians Service Insurance Corporation (WPS Medicare) issued a proposed non-coverage Local Coverage Determination (LCD) for minimally invasive sacroiliac joint fusion (MIS SIJ fusion). WPS Medicare is the Medicare Administrative Contractor (MAC) covering Michigan, Indiana, Iowa, Nebraska, Missouri and Kansas. ISASS drafted a comment letter urging WPS Medicare to review the ISASS coverage criteria on the procedure and all relevant literature in order to develop a comprehensive coverage policy. The ISASS comment letter was submitted on June 17 and ISASS subsequently sent an advocacy action alert email to members in the WPS Medicare jurisdiction urging them to send individual letters to WPS voicing their concerns. The comment period ends on June 27 and WPS Medicare should issue […]
June 17, 2015
Published by Liz Vogt at June 17, 2015
Categories
Action Alert! Attention ISASS Members within WPS Medicare Jurisdiction: Michigan, Indiana, Iowa, Nebraska, Missouri and Kansas WPS Medicare – Proposed non-coverage decision – DL35994 – Percutaneous minimally invasive fusion/stabilization of the sacroiliac joint for the treatment of back pain On April 1, 2015, Wisconsin Physicians Service Insurance Corporation (WPS Medicare) issued a proposed non-coverage determination for minimally invasive sacroiliac joint fusion (MIS SIJ fusion). According to its draft Local Coverage Determination (LCD), WPS Medicare believes that the SI joint is a controversial source of primary low back pain and cannot be effectively isolated as a pain source. Additionally, WPS Medicare states that fusion/stabilization of the SI joint for the treatment of back pain presumed to originate from the SI joint is […]