On February 1, 2014, CORE released an updated version of the CORE Code Combinations for use with the CAQH CORE 360: Uniform Use of CARCs and RARCs Rule. The CORE Code Combinations align with the current published CARC and RARC lists, which are updated at least three times per year.
January 2, 2014 – The Department of Health and Human Services (HHS) published a proposed rule today regarding certification (also referred to as attestation) under the Affordable Care Act, which is open for comments through March 3, 2014. Certification Requirements The 100-page CMS-0037-P proposed rule would require a controlling health
HCIM President & CEO, Michael Wilson, was recently interviewed for “The Benefits of ICD-10 to Medical Practices” article written by Shelly K. Schwartz and published in Physicians Practice: For all the doomsday predictions surrounding ICD-10, it’s easy to forget that the complex new coding system slated to go live next
There’s officially only one year left before the ICD-10 compliance deadline and CMS has no plans to extend the date, so it’s time to get moving! Although the extra year from the ICD-10 extension was intended to give payers and providers time for more testing, many healthcare payer organizations haven’t
Do you often need to add a detail line to your claims? If your claims processors are manually performing the following tasks over and over again, it’s time to automate them! SymKey® can add a claim line for: Bundling codes together in a new line to approve or deny Down-coding
The Budget Control Act of 2011 required mandatory, across the board reductions in federal spending, which has been more commonly referred to as sequestration. CMS Announces FFS Payment Reductions – March 8, 2013 Due to the sequestration, CMS announced mandatory 2% payment reductions in the Medicare Fee-for-Service (Part A and
HCIM’s SymKey® Benefit Plan Loader tool for QNXT™ allows you to update your benefit plan data 6-8x faster! Seamlessly integrates with your QNXT™ claim system and extracts your benefit plans directly into validated spreadsheet templates Stores all your benefit plan data in a centralized location for easy updates Provides accurate
Network Medical Management (NMM), an MSO overseeing eight IPAs in seven Southern California counties, licensed SymKey 3.0 for EZ-CAP in June 2013. They have been using SymKey to automate their claims processing at speeds averaging over 700 claims per hour. During their 30-day trial, SymKey processed 15,000 claims in 24
SymKey 3.0 can identify the corresponding Auth IDs for professional claims, automatically populate the authorization, and then reprice all claim lines. As an added bonus, SymKey is able to run unattended around the clock, at speeds averaging over 700 claims per hour. Talk about time savings! And SymKey works within
Check CMS’ website for the 2014 General Equivalence Mappings (GEMs) for diagnosis codes and inpatient procedure codes. The GEMs show forward/backward mapping between the 2014 ICD-9-CM codes and the 2014 ICD-10 codes. CMS has announced that they will post the 2014 Reimbursement Mappings in October 2013.
For other recent ICD-10 news and resources, visit the CMS ICD-10 website.
If you’re in the ICD-10 testing phase, you may want to view the updated ICD-10 end-to-end testing checklists that CMS and NGS released last month. Download the Payer ICD-10 Testing Checklist
For more information or for vendor and provider checklists, visit CMS’ ICD-10 webpage.
To all our healthcare payer friends, we thought you’d like to know that WEDI recently released a white paper on the EFT and ERA enrollment process:
WEDI’s EFT and ERA Enrollment Process White Paper >>
HCIM’s ACA Operating Rules Services and Software Solutions >>