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News
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Jun 4
2010The Drug Enforcement Administration (DEA) interim final rule to allow for electronic prescriptions for controlled substances became final June 1, 2010. The rule is intended to allow DEA-registered prescribing practitioners to sign and transmit controlled substance prescriptions electronically. The DEA sent a letter to qualified providers dated April 29, 2010 advising them of the ability to submit controlled substances electronically provided they are using software that meets the requirements outlined in the Final Rule.
As an Advanced Certified Vendor with SureScripts, the developers of MediSYS ePrescribe have been working very closely with the SureScripts support team since the interim rule was published on March 31, 2010 to determine the necessary requirements to comply with the rule’s directives. In addition, we will participate in the SureScripts June 11th webinar which will address requirements needed for both certified vendors and authorized prescribers.
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Jun 1
2010The Federal Trade Commission (FTC) has again delayed the deadline for implementation of the "Red Flag" rule until January 1, 2011. The latest deadline was June 1, but practices now have until the first of next year to implement a program to help prevent identity theft. Many feel this legislation puts an unnecessary burden on medical practices for what may have been meant for financial institutions.
Several medical organizations including the American Medical Association (AMA) strongly oppose and have taken action to block the inclusion of medical practices in the "Red Flag" rule by the FTC.
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May 25
2010In a recent notification from Cahaba Government Benefit Administrators®, LLC,, the Medicare Administrative Contractor (MAC) for the states of Alabama, Georgia, and Tennessee, informed providers that the number of duplicate Medicare claims submitted is significant and improper. Below is a statement included in this notification and a link to their article:
Unlike other health insurance payers where it is customary to bill until paid, multiple or repetitive billing to Medicare for a particular item or service is improper. Submitting more than one claim for the same item or service could cause a provider to be identified as an abusive biller, or, if a pattern of duplicate billing is identified, an investigation of potential fraud may be initiated. Please review the Medicare Learning Network article SE0415 found at http://www.cms.gov/MLNMattersArticles/downloads/SE0415.pdf titled “Reminder to Stop Duplicate Billing”.
The notice from Cahaba GBA goes on to explain what the major reasons for this large volume of duplicate claims and way providers can prevent the submission of duplicate claims.
Some of the issues listed in this notification as contributing to a high volume of duplicate claims submissions included:
• provider’s billing software set to automatically re-file when claim is not paid
• Zero payment due to a denial or the allowed amount applied to the deductible on the original claim and the claim is resubmitted in an attempt to receive payment.
• provider who use a billing company that is paid per claim submission and may be automatically re-filing the provider’s claims.
Providers are encouraged to take steps to prevent duplicate claim denials by not using automatic rebill/refile features, checking Remittance Advices, responding to duplicate claim denials (CO18), and checking claim status before resubmitting a claim. In addition, providers are reminded of the 14 day payment floor for electronic claims and asked not to automatically refile claims that are not paid after 30 days.
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May 14
2010CMS Provider Resources emailed the following notice regarding Medicare Retroactive Payment Corrections:
Important Message Regarding Medicare's Implementation of the Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act. One week later, on March 30, the President also signed into law the Health Care and Education Reconciliation Act of 2010. These two new laws have a significant impact on the Medicare program and many of the provisions have effective dates prior to this point in time. Over the past several weeks, the Centers for Medicare & Medicaid Services (CMS) has begun implementing various provisions of the new laws, including those with past effective dates. In addition to implementing these legislative changes, the Medicare Physician Fee Schedule is being updated to include certain corrections, retroactive to January 1, 2010, as prescribed in recently published notices in the Federal Register.
Once Medicare contractors have the new payment files in place, per the above, all claims going forward will be processed at the revised rates. However, we continue to work on the best way to address the many claims that are paid at the rates that were in place before the current corrections and updates are made. Please be on the alert for further information about how CMS will address past claims. Until then, providers should NOT resubmit previously-processed claims affected by the payment changes, as it is likely that these resubmissions may be denied as duplicate claims.
Note: If you have problems accessing any hyperlink in this message, please copy and paste the URL into your Internet browser.
If you know someone who would like to subscribe to a Medicare Fee-For-Service (FFS) provider listserv, go to (http://www.cms.gov/prospmedicarefeesvcpmtgen/downloads/Provider_Listservs.pdf). If you received this message as part of the All FFS Providers listserv, you are currently subscribed to one of eighteen provider listservs. If you would like to be removed from all NIH listservs, please go to (https://list.nih.gov/LISTSERV_WEB/signoff.htm) to unsubscribe. If you would like to unsubscribe from a specific provider listserv, please go to (https://list.nih.gov/cgi-bin/wa.exe?INDEX) to unsubscribe or to leave the appropriate listserv.