|| Alfred H. Moffett, MD, FACOG
Immediate Past Chair and Medicare Liaison
Medicare Liaison Report
The Carrier Advisory Committee for Medicare met on October 19, 2013 in Orlando to discuss various items.
“The SPOT” – Your direct connection to Medicare Data
August 5, 2013 marked the beginning of an exciting new era with the premiere of First Coast Service Options’ Secure Provider Online Tool (SPOT). For the first time, the members of First Coast’s provider community have the opportunity to enjoy the benefits of online data access as an efficient alternative to other customer service channels. In the short time since its initial launch, the SPOT has attracted nearly 2,000 registered users from the J9 provider community. Enhancements scheduled for the near future include access to more detailed claims and payment information, greater versatility in eligibility search options, re-openings, and appeals.
The SPOT not only safeguards proprietary and protected health information (PHI) but also offers providers the advantage and versatility of faster access to:
- Claim Status – check the status of Medicare claims and view any related payment information.
- Benefits/Eligibility – verify a beneficiary’s eligibility status and view his/her benefits data regarding deductibles/caps, preventive services, plan coverage, inpatient, hospice/home health, and Medicare secondary payer (MSP) coverage.
- Payment History – search Medicare claims history for provider payment information by issue date or by check number.
- Data Analysis – analyze billing patterns and improve the provider’s bottom line with detailed data compiled from the provider data summary (PDS) report.
Clarification of HPI Guidelines
Effective for services performed on or after September 10, 2013, contractors shall recognize either the 1995 or 1997 documentation guidelines for evaluation and management (E/M) services for the extended history of present illness element in the history portion of the service billed, regardless of whether these guidelines were used for other portions. This will apply when reviewing the service for both medical necessity and choice of Healthcare Common Procedure Coding System (HCPCS) code billed for that service.
Health care providers and suppliers are required to transition from the use of ICD-9 to ICD-10. The compliance date for implementation of the ICD-10-CM/PCS is October 1, 2014.
ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by Health Insurance Portability Accountability Act (HIPAA). Health care providers, payers, clearinghouses, and billing services must be prepared to comply with the transition to ICD-10, which means:
- All electronic transactions must use Version 5010 standards, which have been required since January 1, 2012.
- ICD-10 diagnosis codes must be used for all health care services provided in the US, and ICD-10 procedure codes must be used for all hospital inpatient procedures. Claims with ICD-9 codes for services provided on or after the compliance deadline cannot be paid.
- Enhance accurate payment for services rendered and facilitate evaluation of medical processes and outcomes.
- Provide significant improvements through greater detailed information and the ability to expand in order to capture additional advancements in clinical medicine.