For issues related to Medicare and Medicaid with numerous associated links to HIPAA, obtaining a UPIN, etc., the Centers for Medicare and Medicaid Services (Formerly HCFA) has an excellent website at www.cms.gov. Additionally, there is information at the AAPA website (www.aapa.org) that will aid you in finding out information about reimbusement. There is also a short video done by Mr. Ron Nelson, AAPA past president and President/CEO of Health Services Associates and HSA Consulting Group Inc. The video goes through some of the Medicare and Medicaid requirements, obtaining a UPIN, etc.
The NPI is here. The NPI is now. Are you using it? By: Mark Vogel
The Centers for Medicare & Medicaid Services (CMS) will be disseminating provider information contained in the National Plan and Provider Enumeration System (NPPES) that is required to be disclosed under the Freedom of Information Act (FOIA), in accordance with the NPPES Data Dissemination Notice (CMS-6060-N) that was published in the Federal Register on May 30, 2007. The Notice encouraged providers who have been assigned National Provider Identifiers (NPIs) to view their NPPES data and to update, change, or delete (where permitted) the data that will be disclosed under the FOIA. Click here for more info
Testimony to the Pennsylvania House Insurance Committee By: Patrick Ivory, PA-C. Printed in the PSPS News Summer 2007
AAPA Reimbursement Watch By: Michael Powe, Director of Health Systems and Reimbursement Policy
By May 23, 2007, every PA who electronically submits claims or transfers health care information must use a National Provider Identifier (NPI) number. More....
National Provider Identifier Activities Begin in 2005. A letter from Mark B. McClellan, MD, PhD.
2006 Nursing Home Billing Codes Changes
Medicaid Reform in Pennsylvania by: Patrick Ivory, MPAS, PA-C, Immediate Past President
The Pennsylvania Medical Society held a meeting recently in Harrisburg and invited representatives from numerous health care provider services in the Commonwealth to discuss the Medical Assistance program (Medicaid) and what can be done to fix the problems with the program. A briefing was given by Mr. Jim Hardy from the Department of Public Welfare and he outlined changes as a result of the new budget in Pennsylvania. It is evident that the systems demands out weights the available resources provided by the federal government and the additional amounts added by the state. The 2005-2006 fiscal year budget calls for the expenditure of $14.2 million dollars. The state per capita spending for Medicaid has increased 180% between 1990 and 2005 and it is estimated to become a lot worse. Click here for more information
Reimbursement Alert
Starting in approximately April 2004, Pennsylvania CMS started to deny claims submitted by PAs for the treatment of skin cancers. Claims were denied if submitted under the PA's number. If the PA submitted the claim incident to their physician the procedure was reimbursed as usual. Denied claims included the series 11600 to 11644 (surgical excision of malignant lesions anywhere on the body) as well as the 17260 to 17284 (destruction of malignant lesions anywhere on the body).
When asked about this sudden change in policy, CMS's response was that treating skin cancers is not in our scope of practice. It was explain to CMS that our scope of practice is determined by the practice agreement with our physicians. Once the practice agreement is approved by the state board of medicine, whatever is in the agreement becomes the PA's scope of practice. Despite our attempts, CMS continues to deny claims made by a PA for the above mentioned codes. We did get the director of CMS to agree that if you resubmit the claim on appeal WITH a copy of your practice agreement (which needs to clearly state that you can treat skin cancers) they will cover the service.
If you regularly perform these procedures check with your billing department to make sure you're getting reimbursed. If this will be a big issue in your office, sit down with your physician and have a serious discussion about how you see Medicare patients. Please contact us if you have any further questions or problems.
Effective January 1, 1998, PAs will be covered by Medicare for all eligible services in all settings recognized by the program. Those most affected by this change will be PAs in urban, suburban, and rural (non-HPSA) office practices, where billing for outpatient services has been done under Medicare's incident-to provisions.
Denied Claims: Steps to Follow
All practitioners, including physicians, occasionally experience claim denials. Reversing these denials depends on how diligent you are, and what process you and your practice implement to fight for the legitimate reimbursement dollars you have earned. As the financial productivity to the practice for all practitioners becomes increasingly scrutinized, you owe it to yourself to make sure that denied claims for medically necessary services are challenged.
Medicare's newly expanded coverage policy for PAs is another milestone in the AAPA's ongoing efforts to enable PAs to extend access to quality medical care to all Medicare beneficiaries. The new rules, released in late March 1997 by the Health Care Financing Administration (HCFA), have generated a great deal of interest among PAs, physicians, billing personnel, and others. The following questions and answers should help to explain the details of Medicare's coverage policy for PAs.