AMA Wire

Wednesday, June 27, 2012

Practice News

Webinar covers what you need to know about audits

Did you know you could be subject to as many as 20 different types of payer audits? A newly archived webinar from the AMA discusses what you can do if you are audited and the steps you can take to minimize your risk of an audit by a private payer.

National expert Dennis Mihale, MD, explains which organizations are conducting audits, why certain physicians and claims are marked for audits, and what differentiates automated audits and comprehensive reviews. Dr. Mihale also details what you should do if you receive an audit notice and how to appeal adverse findings.

At the end of the recording, Dr. Mihale answers questions from physicians who participated in the webinar earlier in June.

View the recording.

HIPAA version 5010 grace period ends June 30

The Centers for Medicare & Medicaid Services (CMS) will begin enforcing use of the version 5010 Health Insurance Portability and Accountability Act (HIPAA) electronic transactions July 1. Failure to use the new transactions will result in rejections, which could disrupt claim payments and cash flow.

Although numerous claims processing and payment interruptions had resulted from the initial transition to version 5010, the AMA worked with CMS and other medical associations to address these problems and is not aware of any remaining widespread issues.

Physicians who encounter claims processing and payment difficulties starting July 1 should speak with their practice management system vendor, billing service, clearinghouse or payer to identify and correct the problem. If the issue remains unresolved, physicians can file an online complaint with the AMA regarding Medicare or other payers. Physicians also can file a complaint directly with CMS.

For Medicare claims, the specific error messages physicians will receive if their claims are rejected after June 30 will vary among Medicare Administrative Contractors. CMS provides a detailed list of rejection error messages for version 4010, which may be similar to what physicians might see after the grace period expires.