Medical Billing Outsourcing

Processing ICD 10 Claims

The move to ICD-10 has apparently evaded most of the obstacles healthcare stakeholders predicted. Despite that, HBMA members have uncovered many challenges in the transition to the new coding system. Members of the association have encountered issues at the Medicare Administrative Contractor level, with claims having to do with National Coverage Determinations, and Local Coverage Determinations.

The problem of rejection rests with the MACs, which have rapidly worked to recognize and correct the issues as and when. Even so, resolving them is taking longer than expected.

CMS recently released a memo to key industry players notifying them that improvements are being worked on. With regard to the NCDs, CMS maintains in the memo that a permanent update will be in place by January 2016. The matter of the LCDs was left unspoken for, but the agency did stress that it would work with the MACs to solve the issue. Claimants who had their applications denied due to the above reasons would have them automatically reprocessed after the corrections are instated.

CMS Extends PQRS, VM Appeals Deadline

CMS has authorized an extension for providers who choose to informally request a review of their PQRS and VM payment adjustment results. Applications for Informal Review Requests previously needed to be in by November 23. Now the deadline is December 16.

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Learn About PQRS Reporting

Any informal review requests will require to be submitted electronically, through the Quality Reporting Communication Support Page (CSP), which will be accessible up to the deadline. Also, the agency has alerted that there will be a downtime for the portal, between, December 3 and December 7. If intending to file an informal request, practices have been advised to do so outside the mentioned time window.

Besides that, CMS announced the self-nomination period for 2016 reporting of PQRS data for Qualified Registries and Qualified Clinical Data Registries as open through 31 January 2016. Hospitals and practices seeking to become a PQRS qualified registry or QCDR for 2016 will need self-nominate themselves before CMS. Said nomination will have to include a declaration of intent for program participation, the PQRS measures and non-PQRS measures, and plan for data validation as required by CMS.

Reporting of PQRS data can be performed through a qualified registry, or using the claims-based method.

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