Jun 10, 2014 | Uncategorized
Seems to be the Season for the Notice of Material Change!
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The health plans are required to send out a NOMC anytime there is a change that may affect provider compensation. nnTimes, must be a changing, as we are seeing an unprecedented number of NOMC notices.nnManaged care contracting is, increasingly, more about strategy than just rates, fee schedules and dates on a page. The health plans now have more competition: more plans, payment models and methodologies. They are also competing not just for the traditional employer business, but also for individuals. We (yes We – as you are a part of it, like it or not) are in a mad race to create and market plans that sound like PPO (with open networks) but are in reality very narrow networks with very specific patient cost share and steerage components.nnNavigation of these wild times requires strategy (both contracting strategy and billing know how)! Let us help you navigate the treacherous currents and eddies and help you be successful…after all it is a $2 Trillion industry, there is plenty of money, it’s just in different places than it used to be.n
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Jun 10, 2014 | Uncategorized
S06.0X0A — Concussion without loss of consciousnessnnS01.01XA — Laceration of scalpnnW16.022A — Fall into swimming pool, striking bottom and causing injurynnY93.12 — Platform divingnnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2015 implementation date. Please don’t hesitate to contact us for all of your training and education needs!
May 16, 2014 | Uncategorized
L55.2 — Sunburn of third degreennY93.17 — Water skiingnnT33.531A — Frostbite of fingersnnY93.23 — Snow skiingnnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2015 implementation date. Please don’t hesitate to contact us for all of your training and education needs!
May 16, 2014 | Uncategorized
The Centers for Medicare & Medicaid Services (CMS) has taken its first step toward improving its efforts to ensure the effectiveness, efficiency, economy, and quality of care quality for Medicare beneficiaries in through the Quality Improvement Organization (QIO) Program.nnLast week, the federal agency announced the selection of Livanta LLC and KePRO as Beneficiary and Family Centered Care (BFCC) would be responsible for the program’s case review and monitoring activities at a broader level than the traditional QIO activities taking place at a more local level.nnBetween them, the two BFCC QIOs will oversee five geographic areas — Livanta (Areas 1, 5), KePRO (Areas, 2–3) — of the United States and its territories:n
Area 1: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Puerto Rico, Rhode Island, Vermont, Virgin IslandsnArea 2: District of Columbia, Delaware, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West VirginianArea 3: Alabama, Arkansas, Colorado, Kentucky, Louisiana, Mississippi, Montana, North Dakota, New Mexico, Oklahoma, South Dakota, Tennessee, Texas, Utah, WyomingnArea 4: Iowa, Illinois, Indiana, Kansas, Michigan, Minnesota, Missouri, Nebraska, Ohio, WisconsinnArea 5: Alaska, Arizona, California, Hawaii, Idaho, Nevada, Oregon, Washington
nEstablished by statute in 1982, the Medicare Quality Improvement Program Program is currently in its earliest phase of transformation which CMS set in motion back in 2011 with the publishing of the 10th Statement of Work (SOW).nn“One of the most critical roles of CMS is to protect the quality and safety of care delivered to beneficiaries. Care needs to be patient-centered and directly engage patients, families, and caregivers,” Dr. Patrick Conway, Deputy Administrator for Innovation and Quality and CMS CMO, said in a public statement. “The quality of care review is essential to ensure care delivered to all beneficiaries meets professionally recognized standards.”n
nnThe next step for improving the QIO Program is expect to take place this July with the award of contracts to organizations responsible for working directly with providers and communities. Shortly thereafter, CMS will release its 11th SOW on August 1.n
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Source: www.EHRIntelligence.com; Kyle Murphy; May 13, 2014.
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May 16, 2014 | Uncategorized
ICD-10 Compliance Date
nOn April 1, 2014, the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93) was enacted, which said that the Secretary may not adopt ICD-10 prior to October 1, 2015. Accordingly, the U.S. Department of Health and Human Services expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning October 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015.n
July ICD-10 End-to-End Testing Canceled: Additional Testing Planned for 2015
nCMS planned to conduct ICD-10 testing during the week of July 21 through 25, 2014, to give a sample group of providers the opportunity to participate in end-to-end testing with Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) contractor. The July testing has been canceled due to the ICD-10 implementation delay. Additional opportunities for end-to-end testing will be available in 2015.nnSource: www.cms.gov; May 2, 2014.
May 5, 2014 | Uncategorized
J30.1 — Allergic rhinitis due to pollennnJ30.2 — Other seasonal allergic rhinitisnnJ30.81 — Allergic rhinitis due to animal (cat) (dog) hair and dandernnJ30.89 — Perennial allergic rhinitisnnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2015 implementation date. Please don’t hesitate to contact us for all of your training and education needs!
