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As the industry back-pedals to accommodate the delay in ICD-10-CM implementation, APS will continue to provide regular installments of our ICD-10 Update newsletter that illustrates the enhanced documentation needed to direct proper diagnosis code assignment and, hopefully, timely reimbursement of claims under the new version.

The Affordable Care Act requires that all providers enrolled with CMS prior to March 25, 2011, revalidate their enrollment information under new screening criteria.  This has been an ongoing effort in which Medicare contractors send notices to begin the process to selected providers on a regular basis.  Providers should not take any action to revalidate until requested by their Medicare Administrative Contractor (MAC).

As part of Medi-Cal’s General Medicine update released in May, California’s State Medicaid program announced plans to discontinue split billing (PC, TC and ZS) for 88 select laboratory codes.  The Bulletin (469) stated that this change was due to be effective July 1, 2014.  The California Society of Pathologists (CSP) has reached out to the DHCS opposing the change, citing that it is inconsistent with the new DRG payment system Medi-Cal uses to reimburse hospitals; which specifically excludes the professional component of anatomic and clinical pathology from the DRG payment.  CSP has since

On June 25th, the Department of Health and Human Services Office of Inspector General (OIG) released a warning to clinical laboratories and physicians that providing compensation to physicians for collecting, processing and packaging of patient specimens and/or establishing a database to collect patient testing data could violate federal anti-kickback law.  The OIG stated in its alert that it “reiterates our long standing concerns about payments from laboratories to physicians in excess of the fair market value of physicians’ services and payments that reflect the volume or value of referra

Per the 2014 AMA CPT text, the following descriptions are given for CPT codes 88360 & 88361:

• 88360-Morphometric analysis, tumor immunohistochemistry (e.g., Her2neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, each antibody, manual
• 88361-… using computer-assisted technology

Q. We received multiple needle core prostate biopsies in one container.  Do we code 88305x1?

In a bi-partisan vote January 1, 2013 the House of Representatives voted 257-167 in favor of the Fiscal Cliff legislation.  The approved plan maintains tax cuts for individuals earning less than $400,000 and couples earning less than $450,000 and raises taxes that make more.  The legislation also directly impacts reimbursement.
 

As of January 2, 2013 Medicare has 5 years to recover overpayments, with interest, from providers.  This is a 2 year extension of the previous 3 year deadline.  This was enacted as part of the American Taxpayer Relief Act of 2012 and is estimated to save $500 million, a projection of the Congressional Budget Office.  Critics of this policy exclaim that it will cost practices more money, understanding Medicare payments must be closely monitored for another 2 years in order to limit exposure.  APS’ contract management system continues to monitor all payments and will be utilized on your behal

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