Current Issues for Practice Managers

Clarification about MedAssurant Medical Reviews Click here for more information

Update on Medicare claims processing - For your information please view the attached document which provides an update and clarification on Medicare claims processing as a result of the passage/veto override of HR 6331. Click here for more information. 

10-Business Day Hold processing Medicare claims. Click here for more information.

BCBS Q Code - Please note that the BCBSM policy related to elimination of the Q code has been amended to the following information.  BCBSM will continue to reimburse physicians for Q0091 (Pap smear prep & conveyance) beyond 8/1/08.  The new effective date will be announced in an upcoming Record article.

Traditional Medicare Benefit Information available soon through web-DENIS. Click here for more information

Michigan Records Guide for Physician Practices 2008 -
Click here (Note - this is a large file and may take some time to open.)

PQRI 2007 Participation Data:
Click Here for the AMA Memo to Federation
Click Here for the Complete Data Set

UHC Premium Designation Program - Click here for more information

ePrescribing Pilot Program Finds Medication Errors are Significantly Reduced,  - Click here for more information

Aetna's Health Care Transparency Initiatives -
Click here for more information
(Note - this is a large file and may take some time to open.)

Medicare NPI Information

NPI: NPPES - IRS Data Match. Click here for more information

Medicare Fee-for-Service Update & Medicare Reminder Regarding Accelerated/Advance Payments. Click here for more information.

Clarification for Identifying Secondary Providers in Medicare Claims & More NPI Roundtable Information. Click here for more information.

NPI: Urgent Message for Medicare Fee for Service Institutional Providers, Click here for more information.

Important NPI Task for Incorporated Individual Providers, Click here for more information.

The NPI will be required for all HIPAA Standard Transactions on May 23rd. - Click here for more information.

NPI Update: Can Your Practice Survive Without Payments? - Click here for more information

Providers can apply for an NPI online at: https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203.

AMA Brochures on Medicare Managed Care Plans
 To help understand the many changes to Medicare’s managed care program, the AMA has developed two new brochures:

Medicare Advantage – Special Needs Plans
Medicare Advantage – Health plan funding and physician reimbursements


Click here to get Adobe Acrobat

The US Centers for Medicare & Medicaid Services now offers the Secure Net Access Pilot (C-SNAP), a comprehensive, secure website and the primary source for Medicare information for patient and claim data. C-SNAP is available 24 hours a day, seven days a week. To register, go to http://www.medicareinfo.com.

CMS Breaking News re: Form CMS-1500. Click here for more information.

Medicare PLUS Blue Reminder
Medicare Advantage claims processing issues have resulted in some delayed or denied claims, over or underpayments and subsequent recoveries. Updates in resolving these problems will appear on BCBS’ web-DENIS.

While issues are being resolved, physician practices currently experiencing problems are being asked to either visit www.bcbsm.com/ma or contact their provider consultant.

Continued problems in resolution can be referred to OCMS for further action.

Blue Cross Electronic Transfers Funds
Blue Cross Electronic Funds Transfer & Online Vouchers
Blue Cross Blue Shield of Michigan is now offering electronic payments and online vouchers to Michigan physicians and other health care providers, including billers of routine vision and hearing services. Physicians can now enroll online for free. Click here for more information.

For past practice manager information, click here.

For more information on any of these issues, contact OCMS Executive Director Donna LaGosh at dlagosh@msms.org or (248)773-4000

Legislative Initiatives
OCMS will work toward legislative remedies to reimbursement issues physician offices are experiencing. Current bills include:


Fair Contracting Legislation
 This month, MSMS will introduce its “fair contracting” legislation, which has received bipartisan sponsorship. Key pieces are being drafted in the legislature as a package of separate bills, thereby allowing MSMS to pursue strategies on an issue-by-issue basis. The goals are as follows:
 
• limit retroactive audit time frames;
• require adequate disclosure of fee screens 
• require that termination be for specified causes
• create a non-discrimination clause for qualified physicians
• prohibit “all products” clauses
• stipulate standards for amending contracts

This legislation will not only deal with BCBSM, but also would address other plans that may grow in strength in the coming years because as health plans continue to grow and antitrust laws constrain physicians, the need for fair contracting legislation has become imperative. For more information, contact Colin Ford, MSMS, at 517-336-5737 or cford@msms.org.

Medical Group Manager Resources
 OCMS hosts regular meetings of practice administrators, billers and office managers. The goal of the meetings is to discuss payer issues of importance to the group and remedies to those issues.

The next meeting is: June 10, 2008 at 9:00a.m. at The Community House, Birmingham.


If you are interested in attending the meetings or have an agenda item , please contact OCMS Executive Director Donna LaGosh at dlagosh@msms.org or (248) 773-4000.

Click here to see Minutes from the January 15, 2008 meeting

Click here to see Minutes from the June 5, 2007 meeting

Click here to see Minutes from the April 17, 2007 meeting

Click here to see Minutes from January 9, 2007 meeting

Click here to see Minutes from November 14, 2006 meeting

Click here to see Minutes from September 12, 2006 meeting

Click here to see Minutes from June 20, 2006 meeting

Click here to see Minutes from April 25, 2006 meeting

Click here to see Minutes from February 7, 2006 meeting

To join the OCMS Reimbursement Listserv, please contact OCMS Executive Director Donna LaGosh at dlagosh@msms.org 

For a complete list of resources offered to the practice managers of OCMS and MSMS members, click here.

BCBS Updates
OCMS meets quarterly with Tom Simmer, MD, vice president of Medical Affairs and chief medical officer for Blue Cross Blue Shield of Michigan, to address problems that physician’s offices are encountering with the insurer. To notify OCMS of a problem your office is experiencing, contact Donna LaGosh at (248) 773-4000 or dlagosh@msms.org. These issues will be added to the agenda of our next meeting with BCBS.

Our next meeting with BCBS is: TBD

Blue Cross Clue Shield of Michigan prepares for the National Provider Identifierm
BCBSM Provider Affiliation Strategy - January 2006
Letter to UAW PPO Patients

Hippa Approved Vendor List
BCBS Reimbursement for Physicians - Let's Fix It Now!

DaimlerChrysler and UAW Health Plan Changes


Click here to get Adobe Acrobat

How Policy Affects Patient Care
Testimony from medical professionals on why legislation is needed to remedy the problems with BCBS

Click on the links below to read. Requires Adobe Acrobat.

Testimony from Frederick Campbell, MD
Testimony from Betty Chu, MD
Testimony from Michael Genord, MD
Testimony from Denise Peplinksi, Practice Manager

Click here to get Adobe Acrobat

If you would like permission to make copies of “Understanding Your Health Insurance Benefits: A Guide for Patients” please e-mail our office. Printed copies are also available at your request. Click here to see the article.

Visit the 
Athenahealth's Database to view PayerView rankings that analyze claim performance data from more than 7,000 providers. To visit the database, click here

Have billing, coding or reimbursement issues you need OCMS' help in resolving?
Click here to submit your issue.


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