Insurance news
New PQRS Remittance Advice Codes Effective July 1
Written by Editor   
Tuesday, June 24, 2014 04:55 PM

Providers participating in the Physician Quality Reporting System (PQRS) through claims-based reporting are reminded that effective July 1, 2014, your EOBs will contain updated Remittance Advice Remark Codes (RARCs) and all old codes will be deactivated on the same date.

201 4 Physician Quality Reporting System (PQRS) Claims - Based Coding and Reporting Principles
Tuesday, May 06, 2014 07:54 AM

The Centers for Medicare and Medicaid Services (CMS) offers a guideline for correctly reporting PQRS codes to prevent a reduction in reimbursement.  The PDF file may be ACCESSED HERE.

ICD-10 conversion date set for Oct. 1, 2015
Written by Editor   
Tuesday, May 06, 2014 07:46 AM

The new ICD-10 start date is Oct. 1, 2015, according to a terse statement from the CMS.HHS “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 Oct. 1, 2015,” the CMS statement said. “The rule will also require HIPAA-covered entities to continue to use ICD-9-CM through Sept. 30, 2015.”

The previous compliance deadline had been Oct. 1, 2014, but that was shot down by Congress in a law signed by President Barack Obama on April 1 that ordered HHS to not set a ICD-10 compliance date any sooner than Oct. 1, 2015.

“A rapid crescendo of frustration and even anger beginning to appear (among) U.S. healthcare providers, especially physicians, that seems to be worsening with each pronouncement. It's past time that a clear and specific communication plan be laid out for all affected in American healthcare.”

Aetna Claims and Appeals Resources
Tuesday, May 06, 2014 07:36 AM

ACA has been regularly updating members on its progress with Aetna regarding the processing of claims containing 97140-59 and CMT. Our most recent release stated that Aetna agreed to pay for 97140 when billed with CMT, if provided to a separate region, and documentation for medical necessity was submitted with the claim.

Unfortunately, ACA has been made aware of wrongful denials of these claims in spite of the new Aetna policy. To assist our members with filing inital claims and appeals in these instances, ACA's Insurance Relations Department has created the following resources:

Our Medical Cousins Complain Too
Written by Editor   
Thursday, April 24, 2014 05:47 AM

"My day is spent navigating around black holes of time suck," one medical doctor complains.  When asked "What frustrates you?"  "The list is endless; there are so many realms in which I'm frustrated," he replied.  Here are a few of the widespread complaints that our medical cousins are sharing:  unwarranted changes in insurance coverage; continuous maintenance of certification; and ICD-10.

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