Most Babies Being Fed Solids Too Soon

HMS Healthcare Management SolutionsAccording to a study released yesterday in Pediatrics, mothers may be starting their infants on solid foods too early, mistakenly believing their children are old enough to graduate from breast milk or formula. Researchers at the Centers for Disease Control and Prevention (CDC) who surveyed 1,334 new moms discovered

93% of women introduce solid foods to their infants before 6 months and 40% did it before the 4-month mark. Child-nutrition experts, including the American Academy of Pediatrics (AAP), recommend waiting until little ones are at least 6 months old before offering them solid foods.

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NY Received $27.5M In Improper Medicaid Payments

Federal regulators at the Department for Health and Human Services (HHS) Office of Inspector General (OIG) say the state of New York took nearly $27.5 million in improper Medicaid payments. A report issued earlier today found 84 out of 100 Medicaid claims submitted did not comply with federal and state regulations.

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Tiptastic Tuesday: Billing With Unlisted Procedure Codes

Occasionally, it is necessary to bill for procedures and services without an established code.  Payors will often deny these claims if they don’t meet certain requirements or they may provide reimbursement at a lower amount than your patient deserves.  Below are some tips for getting around these potential hurdles:

  • Be Prepared:  Before submitting a clai9m with an unlisted procedure code, contact your payor directly and ask about the info that must be provided when billing. Some carriers have their own forms for unlisted services and procedures and they won’t consider other proof of documentation.
  • Suggest A Payment: It’s best to request a specific reimbursement amount with your claim for an unlisted procedure. As justification for the charge, include documentation for a similar procedure code or service. Describe how the procedures compare in terms of difficulty and necessity to make your case.
  • Approaching Denials: If you do receive a denial, reach out to the payor again. You may need to include more specific info, such as x-ray reports or lab reports, for your claim to paid.

Connecticut Wasting No Time Enrolling Uninsured In Marketplace

Connecticut is wasting no time enrolling uninsured residents in the state’s new online health insurance marketplace Access Health CT.  Marketplaces, created under the Patient Protection & Affordable Care Act (PPACA), are set to open nationwide October 1 and are key to expanding health coverage to millions of individuals and small businesses.

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MedPAC: Medicare Should Reduce SNF Payments 4%

In a recent report to Congress, the Medicare Payment Advisory Commission (MedPAC) recommended Medicare payments to skilled nursing facilities should be cut 4% in 2014 and steadily reduced in subsequent years. The council also advised a decrease in rates to achieve $10 billion in savings by 2018.

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Monday Morning Recap

This HMS Healthcare Management Solutions Monday Morning Recap reviews some of the top stories and healthcare highlights you may have missed last week.

CMS Revises Policy For HICN, Name Mismatch

The Centers for Medicare & Medicaid Services (CMS) released a new transmittal reagrding handling claims where the Health Insurance Claim Number (HICN) does not match the beneficiary name associated with that HICN.

The new edit, which goes into effect April 1, 2013, will resolve this issue by providing the submitter with the originally submitted information  when the HICN and name mismatch within Common Working File (CWF) instead of the name of the beneficiary associated with that HICN within CWF.