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Highmark Medicare Services administers the Medicare Fee-for-Services Part A business for Pennsylvania (PA), Maryland (MD), and the District of Columbia (DC), and the Part B business for Pennsylvania (PA), and is the Part B Medicare Administrative Contractor for Maryland (MD), Delaware (DE) and the District of Columbia Metropolitan Area (DCMA). Learn more about us.
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+(UPDATED: 07/17/2008 at 10:45 AM) ATTENTION Pennsylvania Part A! ( click for details)
The FISS Financial system issue which was reported 07/15/08 has been resolved. We have performed a payment validation and have verified that the payment cycle included input from 7/14, 7/15 and 7/16. Highmark Medicare Services has released checks, remittances, EFTs, and ERAs are now available.
- July 23, 2008
MLN Matters Articles From CMS
- July 22, 2008
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Please join Highmark Medicare Services on July 25, 2008 (9:00am) at our offices in Camp Hill, PA for an informative workshop on Outpatient Hospital Services presented in a hospital setting. The topics that will be focused on will be billing diagnostic, rehabilitation and medication services. The workshop will enhance your knowledge about CERT data analysis, demonstrate appropriate billing and encourage Medicare compliance of billing and documentation requirements. This workshop meets the American Academy of Professional Coders' guidelines for 3 CEUs.
New 2008 Medicare Physician Fee Schedule Payment Rates Effective for Dates of Service July 1, 2008 through December 31, 2008 - UPDATE The Medicare Improvements for Patients and Providers Act of 2008 was enacted on July 15, 2008. As a result, the mid-year 2008 Medicare Physician Fee Schedule (MPFS) rate of -10.6 percent has been replaced with the January-June 2008 0.5 percent update, retroactive to July 1, 2008.
Highmark Medicare Services has received the updated MPFS files and is currently validating those files in our test system. We expect to complete the validation within the next two business days. We will continue to update providers of the status of the files via our website and listserv.
- July 21, 2008
CANCELLED - ACCREDITATION Deadlines FOR DMEPOS Competitive Bidding The Medicare Improvements for Patients and Providers Act of 2008 was enacted on July 15, 2008. This new law has delayed the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.
Extension of Payment Rule for Brachytherapy and Therapeutic Radiopharmaceuticals The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), enacted on July 15, 2008, extends the use of the cost to charge payment methodology for Brachytherapy and Therapeutic Radiopharmaceuticals through January 1, 2010.
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+(UPDATED: 07/21/2008 at 11:30 AM) Denied Claims ( click for details)
UPDATE:
As of July 18, 2008 we have reprocessed over half of the claims denied in error. We anticipate that all impacted claims will be completed within the next week. We will continue to provide you periodic updates.
ORIGINAL ALERT:
On June 12, 2008, Highmark Medicare Services Inc. erroneously denied claims and adjustments with message B7 - This provider was not certified/eligible to be paid for this procedure/service on this date of service. This message will be shown on the standard provider remittance (SPR) of the claim and/or adjustment. The adjustment activity on previously paid services automatically generated a demand (refund) request through the Healthcare integrated General Ledger Accounting System (HIGLAS). After reviewing several options to correct this situation, Highmark Medicare Services Inc. has decided to mail the demand (refund) letters. The impacted providers need to repay the amount indicated in the demand (refund) letter to Medicare. If you wish to request immediate offset, please call 1-888-291-2623. All impacted claims and adjustments will be re-adjusted to pay as appropriate under a separate payment. We understand this is an inconvenience to the provider community and apologize, however due to claims processing limitations, this is the most efficient way to resolve this issue.
- July 23, 2008
MLN Matters Articles from CMS
- July 21, 2008
CANCELLED - ACCREDITATION Deadlines FOR DMEPOS Competitive Bidding
The Medicare Improvements for Patients and Providers Act of 2008 was enacted on July 15, 2008. This new law has delayed the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.
Extension of Payment Rule for Brachytherapy and Therapeutic Radiopharmaceuticals The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), enacted on July 15, 2008, extends the use of the cost to charge payment methodology for Brachytherapy and Therapeutic Radiopharmaceuticals through January 1, 2010.
Reinstatement of the Moratorium That Allows Independent Laboratories to Bill for the TC of Physician Pathology Services Furnished to Hospital Patients In the final physician fee schedule regulation published in the Federal Register on November 2, 1999, the Centers for Medicare & Medicaid Services (CMS) stated that it would implement a policy to pay only the hospital for the technical component (TC) of physician pathology services furnished to hospital patients.
Delay of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program The Medicare Improvements for Patients and Providers Act of 2008 was enacted on July 15, 2008. This new law has delayed the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. Items that had been included in the first round of the DMEPOS Competitive Bidding Program can be furnished by any enrolled DMEPOS supplier in accordance with existing Medicare rules. Payment for these items will be made under the fee schedule. Additional guidance regarding this new law will be forthcoming.
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