Part B News | Editors' Blog

What the 5010 paperwork delay means for you

by: Danielle Cralle Jul 18, 2011

You already know that Jan. 1, 2012 is the deadline to implement the new ANSI 5010 standard for electronic transactions of HIPAA-protected data. But you might be wondering why CMS recently announced a delay in the “implementation of the PWK (paperwork) segment associated with [the test of the 5010] claim transaction originally scheduled for July and October 2011.”

AMA: Private plans wrong on 1 in 5 claims in 2011

by: Grant Huang Jun 20, 2011

Nearly one in five of your private payer payments were inaccurate in 2011, according to the AMA's latest "National Heatlh Insurer Report Card," released June 20. The average rate of inaccurate payments is 19.3% in 2011, up from 17.3% in 2010, the AMA says. That 2% jump comes out to a $1.5 billion increase in administrative costs to the health system, the AMA estimates. "A 20% error rate among health insurers represents an intolerable level of inefficiency that wastes an estimated $17 billion annually," AMA Board Member Barbara McAneny, MD, said in a prepared statement.

Claims for SNF codes were incorrectly denied

by: Grant Huang Mar 22, 2011

A wide swatch of skilled nursing facility (SNF) services, primarily for ultrasound and echocardiography, were incorrectly denied between Jan. 1 and March 14, 2011. The incorrect denials were caused by Medicare contractors not updating their claims processing system edits to include a total of 37 codes in the 76000 code series, CMS says.

CMS: Wellness visits done in hospital settings will be held until April

by: Grant Huang Mar 14, 2011

CMS has issued a reminder that annual wellness visit (AWV) services rendered in the hospital setting (inpatient or outpatient) will be held by contractors and not paid until April 3. This only applies to AWVs that are billed alone on a claim; when the AWV is billed with another service, the entire claim will be processed, the agency says. The reason is that Medicare contractors must update their claims processing systems; they won't be ready to process standalone AWVs until April 3.

Palmetto prepares for MAC transition in Virginia

by: Grant Huang Mar 7, 2011

Providers in Virginia are currently under the jurisdiction of TrailBlazer for Part B Medicare claims, but they'll soon be dealing with Palmetto GBA instead. It's another milestone in the ongoing Medicare Administrative Contractor (MAC) transitions, which have been carried piecemeal thanks to delays from protests by the MACs and would-be MACs. Starting March 19, the J11 A/B MAC for Part B services in Virginia will be Palmetto GBA, a subisdiary of BlueCross BlueShield of South Carolina.

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