Professional Courtesy/Insurance Only

Posted May 16, 2008 in Reimbursement

From the AAOMS Today archives, read the article "Professional courtesy a hot topic at first-ever OMS Billing Conference".

Tags: Professional Courtesy, Common Reimbursement Concerns

Avoid NPI Related Claim Rejections – Only 35 Days Left to Comply!

Posted April 22, 2008 in Practice Management

AAOMS staff has recently heard from several members receiving NPI related claim rejections. This is the time to be submitting claims with both your NPI and legacy number (eg, Medicare UPIN, BCBS provider number, etc. preceded by the appropriate qualifier) and more importantly the time to be testing some claims using the NPI alone. This will allow Medicare and other carriers to validate your NPI number and ensure that there will not be any problems when legacy numbers are completely phased out and the NPI officially becomes the sole identifier on May 23rd. This is only 35 days away!

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Tags: NPI

CMS 1500 Form Accommodates Reporting of Tooth Numbers

Posted April 22, 2008 in Practice Management

As reported in the January 2008 AAOMS Advocacy e-Newsletter, a nearly three year effort to make an OMS-friendly change to the CMS 1500 claim form instructions has finally come to fruition. Previous denials of dentoalveolar procedures as duplicate submissions should be fewer given the recent updates to accommodate the reporting of tooth numbers.

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Tags: CMS 1500

PQRI – CMS Says 16% of Eligible Providers Participated in 2007

Posted April 22, 2008 in Practice Management

CMS recently reported that between July and November 2007, 99,000 professionals who fall under the Part B physician fee schedule submitted quality data at least once. Submissions were from all 50 states and the District of Columbia. Among the top specialties reporting PQRI (Physician Quality Reporting Initiative) measures were anesthesiologists, ophthalmologists, and emergency medicine physicians.

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Tags: Pay for Performance

The NPI is here. The NPI is now. Are you using it?

Posted March 18, 2008 in HIPAA

CMS has found a significant number of instances where either the Legal Business Name (LBN) and/or Employer Identification Number (EIN) of an organization health care provider who has been assigned an NPI do not match Internal Revenue Service (IRS) records. In some cases, this is caused by health care providers who are individuals who erroneously applied for NPIs as organizations and who reported their Social Security Numbers in the EIN field. As a first step to improving the quality of information in the National Plan and Provider Enumeration System (NPPES), we are requesting that organization health care providers verify their LBN and EIN within NPPES. This is especially important if the organization health care provider is experiencing any Medicare claims processing issues.

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Tags: NPI