Archive for October, 2010

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NPI Crosswalk File Issue Requires Resubmission of Rejected Claims

Wednesday, October 27th, 2010


National Government Services has identified an issue with the daily National Provider Identifier (NPI) crosswalk file. The issue may have potentially caused claims to reject in error. It began on or around October 12, 2010 and impacted all Part B providers in Connecticut, New York, Indiana and Kentucky.

The problem has been corrected. Not all claims would have rejected during this timeframe. However, if claims were incorrectly rejected as a result of this issue for claims on or around October 12 through October 25, 2010 they must be resubmitted by providers. National Government Services is attempting to identify the rejected claims and will track the issue through next week to make sure it is completely resolved.

Incorrectly rejected claims can be identified via the following messages:

  • N290 - Missing/incomplete/invalid rendering provider primary identifier
  • N257 - Missing/incomplete/invalid billing provider/supplier primary identifier
  • N433 - Resubmit this claim using only your National Provider Identifier (NPI)

National Government Services, Inc.
Corporate Communications

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All Pregnant Women Should Get the Flu Vaccine

Monday, October 18th, 2010

Flu Prevention is Essential Prenatal Care

Washington, DC — All pregnant women, regardless of trimester, should get the influenza vaccination during the flu season, according to new recommendations issued today by The American College of Obstetricians and Gynecologists and published in the October issue of Obstetrics & Gynecology. The College emphasizes that preventing the flu during pregnancy is an essential element of prenatal care and that it is imperative that physicians, healthcare organizations, and public health officials improve their efforts to increase immunization rates among pregnant women.

Last week, the CDC, along with The College and other medical organizations, encouraged all physicians and health care providers to urge their pregnant and postpartum patients to get vaccinated against the seasonal flu.

Annual flu vaccination is crucial for pregnant women because the immune system changes during pregnancy, which results in women being at increased risk of serious complications if they get the flu. Flu vaccination performs double duty by protecting both pregnant women and their babies. Babies cannot be vaccinated against the flu until they are six months old, but they receive antibodies from their mother which help protect them until they can be vaccinated.

“The flu is a highly infectious virus and can be especially serious for the very young, those with certain medical conditions, and pregnant women,” said Richard N. Waldman, MD, president of The College. “Pregnant women were disproportionately affected by flu complications last year—some went into premature labor, some developed pneumonia, and unfortunately, some died.”

Vaccination early in the flu season is optimal, but can be given at any time during this period, regardless of the stage of pregnancy. The College advises that all women who are or become pregnant during the annual flu season (October through May) get the inactivated flu vaccine. Women can also receive the flu vaccine postpartum and while they are breastfeeding if they missed it during pregnancy. The live attenuated version of the flu vaccine (the nasal mist) should not be given to pregnant women.

According to the CDC, the seasonal flu vaccine is made the same way each year. “The only difference from year to year is that new strains of virus are used to make the vaccine based on which are predicted to be most prevalent,” said William M. Callaghan, MD, the Centers for Disease Control and Prevention (CDC) liaison to The College’s Committee on Obstetric Practice. There have been no studies showing adverse effects of the inactivated flu vaccine for pregnant women or their children, according to The College. “Millions of pregnant women have received the flu vaccine over the past 45 years, and no studies have shown harm to them or their babies,” said Dr. Callaghan.

Despite concerns about thimerosal, a mercury-containing preservative used in some vaccines, there is no scientific evidence that it causes harm to women or their infants. The only side effect is the occasional local skin reaction at the injection site. “There are seasonal flu vaccines that don’t contain thimerosal, so people who remain concerned can ask for those,” said Dr. Callaghan.

Dr. Callaghan notes that The College’s recommendation to increase the vaccination rate among pregnant women dovetails with the CDC’s push for physicians to offer the flu vaccine to every patient age six months and older at every opportunity.

Committee Opinion #468, “Influenza Vaccination During Pregnancy,” is published in the October 2010 issue of Obstetrics & Gynecology.

# # #

The American College of Obstetricians and Gynecologists is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 55,000 members, The American College of Obstetricians and Gynecologists strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care.

Posted in FLU/IMMUNIZATION UPDATES | No Comments »

Workers’ Comp Board Approved New Fee Schedule

Wednesday, October 13th, 2010

Doctors who treat workers’ compensation patients will see some important, positive changes implemented shortly, including increases in reimbursement rates and treatment guidelines that authorize most testing and treatments without an insurer’s prior approval.

The Workers’ Compensation Board has proposed a new fee schedule that includes an across-the-board 30% increase to the Evaluation and Management services codes, effective December 1, 2010. Over the next twelve months, the Board will also conduct a comprehensive review and revision of the physician fee schedule, as well as other health care provider fee schedules.

The NYS Workers’ Compensation Medical Treatment Guidelines will become the mandatory standard of care for the mid and low back, neck, shoulder, and knee, effective for dates of service on or after December 1, 2010. These four body parts were chosen because they represent the most frequent claims and the highest medical costs.

The Medical Treatment Guidelines will:

  • Establish a standard of medical care for injured workers,
  • Expedite quality care for injured workers,
  • Improve the medical outcomes for injured workers,
  • Speed return to work by injured workers whenever possible,
  • Reduce disputes between payers and medical providers over treatment issues,
  • Increase timely payments to medical providers, and reduce overall system costs.

The Medical Treatment Guidelines are mandatory for all work-related injuries or illnesses to these four body parts experienced by employees in New YorkState. With few exceptions, all treatment in accordance with the Guidelines is pre-authorized, so providers will no longer have to obtain prior approval if their treatment conforms to the Guidelines. The regulations require that insurers pay providers for services rendered in accordance with the Guidelines. Treatment that is outside the Guidelines will not be paid unless a variance is approved by the insurer or the Board.

It is essential for medical providers and their staff to become familiar with the Guidelines and the new procedures and forms required to implement the Guidelines. The Board is collaborating with stakeholder groups and provider associations to offer a comprehensive training program. All system participants are encouraged to take the available training to ensure a smooth transition into the new Medical Treatment Guideline process.

Free Web-based, Legal, CME, and CCE Training

A major component of the training program is free web-based training. The courses are available on the Board’s website.

There are several programs available, each designed for different audiences. The medical provider program is accredited for CME credits. There are also courses designed for medical providers’ staffs, and other non-medical persons.

The topics covered include: Medical Treatment Guidelines General Principles, Mid and Low Back Guidelines, Neck Guidelines, Shoulder Guidelines, Knee Guidelines, and Forms and Processes.

Please contact the Board’s Bureau of Health Management at (800) 781-2362 if you have any questions. Additional information on the Guidelines may also be found on the Board’s website under Board Announcements at www.wcb.state.ny.us.

Questions and Additional Information

If you have any questions or suggestions, please contact the Board’s Bureau of Health Management at (800) 781-2362 .

Educational Seminars

In order to educate physician on the new WCB Guidelines, the following seminar is being offered at: Nassau Academy of Medicine – Wed., Dec. 15

An administrative overview of the Workers’ Compensation Reform with emphasis on the Medical Treatment Guidelines also featuring Regina McNally VP of MSSNY’s Socio-Medical Economics Division, and David Austin from the NYS Workers’ Compensation Board, on

Wednesday, December 15,   from 9-11 am at the Nassau Academy of Medicine, 1200 Stewart Ave., Garden City.

Pre-registration is required due to limited seating.

The seminar is free for Nassau County members and Nassau Academy of Medicine members and staff.

The cost is $20 for non-members and their staff. Payment must accompany registration. Make checks payable to Nassau Academy of Medicine and mail to: 1200 Stewart Ave. Garden City, NY11530.

For further information, call 516-832-2300 or email nassaumed@verizon.net

Posted in WORKERS' COMPENSATION UPDATES | No Comments »

OIG Increases Auditing Efforts – Resource can help physician practices prepare

Thursday, October 7th, 2010

In September 2010, the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services published its 2011 Work Plan, which became effective on Oct. 1, 2010.  The Work Plan describes the areas in which the OIG will focus specific audit, investigation, enforcement and compliance activities.  The OIG indicated that it will review the extent of potentially inappropriate payments for evaluation and management (E&M) services. The OIG stated that Medicare contractors have noted an increased frequency of medical records with identical documentation across services. Visit the OIG Web site at http://oig.hhs.gov/publications/workplan/2011/ to access its Work Plan.

The AMA’s new Practice Analysis Tools for Healthcare (AMA PATH™) can help physicians analyze their individual coding and billing practices and compare them with national averages by specialty.  Using AMA PATH, a physician can, for example, analyze his or her billing patterns with respect to individual E&M codes and, in so doing, enable the physician to identify and rectify any billing or coding practices or patterns that might draw the attention of the OIG or other governmental agencies.  Visit www.ama-assn.org/go/amapath to learn more about this online tool, special introductory offers and AMA member discounts!

AMA Practice Management Center

515 N. State St.
Chicago, IL 60654

F: (312) 464-5541

practicemanagementcenter@ama-assn.org

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NGS Ordered and Referred Services Webinar Is Now Open for Registration

Wednesday, October 6th, 2010

National Government Services Ordered and Referred Services Webinar Is Now Open for Registration

Attention Part B Providers

Are you aware of the new ordering/referring edits that will be activated in the Medicare Part B claims processing system as of January 3, 2011?  If you order/refer services, have you taken steps to find out or ensure that you are in the PECOS database? If you perform ordered/referred services, do you know how to avoid claim denials related to these new edits? If your answer to any of these questions is “no”, then you don’t want to miss this one-hour Webinar!

Join us for a Webinar on October 19, 2010

Space is limited.

Reserve your Webinar seat now at https://www1.gotomeeting.com/register/833135792.

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Training on the Medical Treatment Guidelines

Tuesday, October 5th, 2010

Date: September 30, 2010

The Workers’ Compensation Board (Board) is preparing to implement a major change in the manner medical care is provided to injured workers. The NYS Workers’ Compensation Medical Treatment Guidelines will become the mandatory standard of care for the mid and low back, neck, shoulder, and knee, effective for dates of service on or after December 1, 2010. These four body parts were chosen because they represent the most frequent claims and the highest medical costs.

The Medical Treatment Guidelines will:

  • Establish a standard of medical care for injured workers,
  • Expedite quality care for injured workers,
  • Improve the medical outcomes for injured workers,
  • Speed return to work by injured workers whenever possible,
  • Reduce disputes between payers and medical providers over treatment issues,
  • Increase timely payments to medical providers, and
  • Reduce overall system costs.

It is essential for medical providers, insurers, legal professionals, and their staffs to become familiar with the Guidelines. The Medical Treatment Guidelines are mandatory for all work-related injuries or illnesses to these four body parts experienced by employees in New York State. With few exceptions, all treatment in accordance with the Guidelines is pre-authorized, so providers will no longer have to obtain prior approval if their treatment conforms to the Guidelines. The regulations require that insurers pay providers for services rendered in accordance with the Guidelines. Treatment that is outside the Guidelines will not be paid unless a variance is approved by the insurer or the Board.

Variety of Training Opportunities Offered

This is a completely new process that involves new procedures, with both new and revised forms, so the Board is collaborating with many stakeholder groups to offer a comprehensive training program. The Board is strongly encouraging medical providers, insurers, legal professionals, and their staffs to take the available training, to ensure a smooth transition into the new Medical Treatment Guideline process.

Free Web-based, LEGAL, CME, and CCE Training

A major component of the training program is free web-based training. The courses will be available starting October 4, 2010 on the Board’s web site, at the following URL: http://www.wcb.state.ny.us/content/main/hcpp/MedicalTreatmentGuidelines/MTGOverview.jsp

There are several programs available, each designed for different audiences. The medical provider program is accredited for CME credits; the chiropractor program is accredited for CCE credits. There are also courses designed for attorneys and claimant representatives, as well as for insurers, medical providers’ staffs, and other non-medical persons.

The topics covered include:

  • Medical Treatment Guidelines General Principles,
  • Mid and Low Back Guidelines,
  • Neck Guidelines,
  • Shoulder Guidelines,
  • Knee Guidelines, and
  • Forms and Processes.

CLE Training

In addition to the web-based legal training, the Board, in cooperation with Albany Law School, will offer a Continuing Legal Education (CLE) program on the Medical Treatment Guidelines. The program, worth 3.5 CLE credits including .5 hours of Ethics, is tentatively scheduled for the morning of November 3, 2010, and will be broadcast to locations around the state. No hearings will be scheduled for that morning to allow practitioners to attend the program. More information concerning the CLE program will be placed on the Board’s web site, www.wcb.state.ny.us, when it becomes available.

In preparation for the CLE program, it is recommended that legal professionals take the free web-based training and become familiar with the various standards of care that the Guidelines specify for treatment of injuries to the mid and low back, neck, shoulder, and knee. It may also be helpful to review some of the new Board forms and processes concerning use of the Medical Treatment Guidelines.

Questions and Additional Information

Please contact the Board’s Bureau of Health Management at (800) 781-2362 begin_of_the_skype_highlighting (800) 781-2362 end_of_the_skype_highlighting if you have any questions. Additional information on the Guidelines may also be found on the Board’s web site under Board Announcements at www.wcb.state.ny.us.

You are strongly encouraged to review the information on the Board’s web site regarding the Guidelines and to take advantage of the available training. Thank you for your cooperation in this critically important initiative.

Posted in WORKERS' COMPENSATION UPDATES | No Comments »

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