URGENT: NPI Alert - We Need Your Help!
As you are aware, the National Provider Identifier (NPI) deadline is less than two weeks away.
CMS has stated that they have no plans to extend the NPI contingency timeframe past May 23, 2008.
During a recent exercise Medicare conducted with numerous clearinghouses on May 7, 2008 the clearinghouses "stripped off" legacy numbers contained on any claims they received and forwarded them onto Medicare with just the NPI numbers.
Medicare reported that this drill resulted in a low claims rejection rate. The purpose of this drill was to determine what the situation may look like after May 23rd when just the NPI number will be the only identifier permitted on claims.
The AMA is concerned that while this drill may have been helpful, it does not include the numerous physicians who are presently unable to bill Medicare and thus are sitting on their claims due to being required to re-enroll or other NPI matching problems. Medicare has asked the AMA for information on:
- Names of physicians who are unable to submit claims now due to enrollment / NPI matching problems
- Where they are located (city / state)
- The dollar amount of claims they are sitting on
- A phone number (Medicare has said it will not be able to reach out to everyone)
- Their Medicare legacy number(s) / NPI number(s)
They would like to forward this information onto CMS by no later then Monday COB.
Therefore, please send them this information by noon, Monday, May 19 to Ms. Mari Savickis at the e-mail below.
If you have any questions, please contact Mari Savickis at Mari Savickis or call at 202-789-7414.
NYSID OGC Issues Opinion on Balance Billing
The New York State Insurance Department's Office of the General Counsel (NYSID OGC) has issued an opinion on balance billing by physicians who are non-participating or not in the insurer network.
In brief, the question is always asked: Can a physician charge the patient the difference between the provider's charges and the amount paid by the insurer if the physician is not in the insurer's network? And, would the same apply to a patient in a health maintenance organization ("HMO")?
The answer to both questions is yes.
Under most circumstances, a non-participating physician may charge the patient the difference between the physician's own charges and those covered by the patient's insurer and, where the patient is covered by an HMO, the answer would not change.
To read the actual opinion (and to have it for purposes of future documentation if needed), go to:
OGC Opinions
NYSOS Legislative Positions Posted on Critical Issues
NYSOS has initiated a new feature on the Legislative News page where issues of critical importance to Ophthalmologists will be posted.
This section will outline the position of the Society on matters related to legislation pending in Albany and Washington.
To read more, go to:
Legislative News
New Member Benefit - Microwize MediNotes EMR
The New York State Ophthalmological Society and Microwize Technologies have partnered to bring you an offer that makes EMR an attainable goal.
With so many electronic medical record systems on the market today, it's difficult to wade through the features and functionality of each system to make sure that it fits the needs of your busy practice.
MediNotes has been specifically designed to stand out in the market, with a design that eliminates navigation and makes multi-tasking a reality.
Whether you're looking for a complete software suite including medical billing and EMR software, or just looking to add EMR to your existing billing software, MediNotes has the right solution for your practice and a discount applies against all EMR and Billing software.
To read more, go to:
Microwize MediNotes
Update to Medicare Administrative Contractor Activities for New York
The Centers for Medicare & Medicaid Services (CMS) recently announced that National Government Services (NGS) has been awarded a contract of up to five years for the combined administration of Part A and Part B Medicare claims payment in New York (and Connecticut).
NGS will serve as the first point of contact for the processing and payment of Medicare fee-for-service claims from hospitals, skilled nursing facilities, physicians and other health care practitioners.
The contractor will take on the claims payment work now performed by two fiscal intermediaries and four carriers in these two states.
This means that New York claims processing and other functions will be phased out from GHI Medicare and HealthNow - Upstate Medicare Division and moved to NGS.
The schedule for the changeover from GHI Medicare and the Upstate Medicare Division is as follows:
- GHI Medicare - July 2008
- UMD - September 2008
Letters from these carriers will be issued shortly so please look for them in the mail.
As the A/B MAC contractor, NGS will immediately begin implementation activities and will assume full responsibility for all the claims processing work and related activity in its two-state jurisdiction no later than November 2008.
As more information becomes available, we will keep you posted.
Or, for guidance on this issue, contact us through the Third Party Insurance Help Program.
Final Order Issued on Blues Settlement
The BCBSA settlement Final Order was filed April 21, 2008 by a federal court in Miami and allows the signatory medical societies to directly assist physicians when a BCBS plan or subsidiary has failed to honor their commitments under the settlement.
A number of key issues were addressed and are now or will soon be in effect to include:
- No automatic downcoding
- No overpayment recovery more than 18 months from the date of claim payment
- No retroactive retraction of a pre-certified medical necessity determination
See Implementation Dates below to see when the carriers must implement various provisions.
For particulars as to all the terms the plans are now held to, go to:
AMA Update (Adobe File)
IMPORTANT: For the schedule of Implementation Dates, go to:
Schedule of Implementation Dates (Adobe File)
For a list of the Blues plans that have settled, go to:
New York (Adobe File)
New Jersey (Adobe File)
For guidance on this issue, contact us through the Third Party Payer Insurance Help Program.