ChiliMBS Provider's Alert!

Updated on:  Thursday, November 02, 2006

**Please note that all hyperlinks on this page will create a new window in your browser not located within our website.

• December 6, 2002  OCR Releases Guidance on Final Modified Privacy Rule  (.pdf file)

• December 3, 2002  Impact of Physician Cuts in NY (.pdf file)

• November 28, 2001 Senate Passes Bill to Delay HIPAA Transactions Late yesterday afternoon, the Senate passed without amendment and by unanimous consent a bill, S.1684, to delay implementation of the transactions and code sets standards for one year until October 16, 2003. According to Tom Gilligan, Executive Director of AFEHCT, the bill also states that nothing in the bill affects the implementation of the HIPAA privacy regulation. 
  The House is still trying to move its bill, H.R.3323, introduced by Dave Hobson. The House and Senate staff are expected to meet Friday to discuss how they can reconcile the differences between the two very different bills. 
  Gilligan reports the goal of both the House and Senate supporters of "delay" is to pass the Senate and the House by the end of this session of Congress. That could be as soon as December 7 or as late as December 21. 
  Read the Senate's bill (PDF format).

10/25/01    Upstate Medicare Billing Guides!  (courtesy of Upstate Medicare Division)

• The Appeals Process
• Basic Billing Guidelines
• Form HCFA-1500 Completion Instructions
• Global Surgery Policy
• Health Professional Shortage Area (HPSA) Listing
• Limitation of Liability
• Limiting Charge
• Medicare Secondary Payer Guide
• Modifier Reference Guide
• Notices for Elective Surgery
• Operation Restore Trust
• Why Participate With Medicare?

9/18/01 Important Notice!  NY State Education Department & the Office of the Professions

"For licensed professionals who are calling during this crisis situation who may be licensed in other States, but not in New York State, or who are licensed in this State but not currently registered in this state, this advisory is to let you know that the Education Law specifically permits the furnishing of medical assistance in an emergency. The Education Law would therefore permit you and other health care professionals to provide medical assistance in this crisis".

"On September 11, Governor Pataki issued a call for emergency medical volunteers and blood donations. Physicians wishing to volunteer should call 1-518-431-7600; nurses should call 1-800-628-0193; other professions should call 1-800-801-8092".

8/7/01  
NY STATE INSURANCE DEPARTMENT ANNOUNCES ADOPTION OF FRAUD-FIGHTING REGULATION - Superintendent of Insurance Gregory V. Serio announced that the Department has submitted to the Department of State its comprehensive insurance fraud-fighting regulation for final promulgation. Regulation 68 will be effective as of September 1, 2001... Regulation 68 institutes new timeframes for accident victims to report a claim and medical providers to submit claims for payment--eliminating existing loopholes that have been exploited as opportunities for fraud and abuse. It reduces the time medical providers have from each treatment to submit claims for payment from 180 days to 45 days while it maintains the amount of time the carrier has to pay on claims.

Click here to read more: NY State - Regulation 68

Office of Inspector General -SPECIAL FRAUD ALERTS! 

• RENTAL OF SPACE IN PHYSICIAN OFFICES BY PERSONS OR ENTITIES TO WHICH PHYSICIANS REFER

• Anti Kickback Information

• Publication of 5 Special Fraud Alerts (12/19/94) addressing:
  • Joint Venture Relationships
  • Routine Waiver of Part B Co-payments/Deductibles
  • Hospital Incentives to Referring Physicians
  • Prescription Drug Marketing Practices
  • Arrangements for the Provision of Clinical Lab Services

Don't let error-plagued 'superbills' turn into super compliance headaches!  

HCFA 855 Enrollment Application - Section 1, Part D, questions 1-5, is mandatory!

• AHA NEWS NOW Special Report 
  Thursday, April 12, 2000
  No delay for HIPAA privacy rule, HHS says...Health and Human Services Secretary Tommy Thompson announced this morning that President Bush has decided against delaying or substantially changing
  HIPAA privacy regulations scheduled to take effect Saturday.  Click here to read more!

• New York Mulls Over IPA Reserve Requirement - New York is close to requiring the state's independent practice associations to keep financial reserves at a level greater than what is required of the state's HMOs.

• Provider Views on HIPAA  

• Patient Views on HIPAA  

• Payer Views on HIPAA  

• Learn more about HIPAA  

• March 2001 Bulletin-Upstate Medicare Division  

  Complementary Crossover Insurance Update

  Medicare automatically sends claims to companies who participate in the complementary crossover program based on eligibility information we receive from the crossover insurance company. The 27 plans participating with the Upstate Medicare Division, along with their affiliates, are listed.

• March 2001 Bulletin-Upstate Medicare Division  

  Elimination of HCFA Free Billing Software!   

  With the advent of the Health Insurance Portability and Accountability Act (HIPAA) electronic transaction standards, there will no longer be Medicare specific electronic formats....HCFA will require UMD to begin phasing out the free billing software requirement effective FY2004, approximately 1 year after HIPAA standards are implemented. This will give our providers enough time to find substitute software that can work with all payers. You will be notified when the transition period will begin to phase out the free billing software.

• Surgical Group Sued For Defrauding Blue Cross/Blue Shield (02/01/01)- Blue Cross/Blue Shield is suing the Genesee Valley Cardiothoracic Group for $1.2 million. They are accusing the award winning team of heart surgeons of insurance fraud. The lawsuit follows a $2 million settlement between the group and Medicaid. (click here to read more:  Billing)

• DEPARTMENT FINES COMMUNITY HEALTH PLAN $1 MILLION
  FOR INSURANCE LAW VIOLATIONS (1/24/2001) - Superintendent of Insurance Neil D. Levin today announced that the Department has fined Community Health Plan $1,000,000 for violations of the New York State Insurance Law. These violations occurred during the period from...(click here to read more:  Billing)

• ROCHESTER, NY - ViaHealth battles losses at Genesee and Rochester General - (October 13, 2000) Rochester General and Genesee hospitals will be merged under one license, and ViaHealth officials will decide over the next six months which services each hospital will provide.  The moves should help stem operating losses for ViaHealth -- the health care system that runs the hospitals...(click here to read more:  ViaHealth Battles).

• ROCHESTER, N.Y. - The Strong Health system and BlueCross BlueShield of the Rochester Area have agreed to discontinue the StrongCare health insurance product as of December 31, 2001.

• ROCHESTER, N.Y. - Because of changes in state and federal regulations, up to half of the children who are now covered through the Child Health Plus program could be required to switch their insurance coverage to Medicaid or a Medicaid managed care plan such as Blue Choice Option.

• Upstate Medicare - Chiropractic X-Ray Requirement Update
  Effective for claims with dates of service on or after October 1, 2000, when an x-ray is used to demonstrate subluxation, the date of the x-ray must be entered in Item 19 of the HCFA-1500.
  Here is the link to read more about this update, and for the instructions on documentation:  Upstate Medicare's Hotline Bulletin (Sept Issue) Chiropractic X-Ray Requirement Update

[ Return to Physician's Resources ] [ Benefits of ChiliMBS ] [ Services ] [ Description of Services ] [ FAQ's ] [ Fees ] [ FREE CONSULTATION! ] [ Provider's Alert! ] [ Register ] [ Compliance Program ]

Copyright © 1999-2006 Chili Medical Billing Services. All rights reserved.

Please direct questions and/or comments to the Webmaster.
Revised: November 02, 2006