Archive for March, 2015

Medicare Physician Fee Schedule

The negative update of 21% under current law for the Medicare Physician Fee Schedule is scheduled to take effect on April 1, 2015.  Medicare Physician Fee Schedule claims for services rendered on or before March 31, 2015, are unaffected by the payment cut and will be processed and paid under normal procedures and time frames.  The Administration urges Congress to take action to ensure these cuts do not take effect.  However, until that happens, CMS must take steps to implement the negative update.  Under current law, electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt.  CMS will notify you on or before April 11, 2015, with more information about the status of Congressional action to avert the negative update and next steps.

Radiology Providers: Identical Services on the Same Claim

Palmetto GBA would like to remind providers of the importance of the correct use of modifiers when filing claims to Medicare.  Research has revealed that a number of radiology claims contained incorrect usage of CPT modifiers when billing for identical services on the same claim.  In the near future, we will begin to monitor these claims through our Palmetto GBA Advanced Clinical Editing (P-ACE) system. Providers who have claims submissions that meet this criteria will receive a ‘Smart Edit’ on your claims acknowledgement transaction report (277CA) signifying the need for correction and resubmission of your claim.

Applies to:
Jurisdiction 11 Part B//General
Jurisdiction 11 Part B//Radiology