In Context

400th Usual, Customary, & Reasonable Client, Lone Star TPA Calls Upon Context 4 Healthcare

2012-01-18T13:56:00.002-06:00

Context 4 Healthcare, Inc. announced today that they have added Lone Star TPA of Tyler, TX as their 400th client utilizing its Usual, Customary & Reasonable health payment benchmarking databases.

“We are pleased to have added Lone Star TPA as number 400.” said Mark Earles, President and CEO of Context 4 Healthcare. “Lone Star TPA provides benefit design and administration services to employee sponsored health plans in a very complex and challenging market. Our health payment benchmarking solutions will empower Lone Star’s mission of providing value added partnerships to its clients.”

“Attaining our 400th UCR client is an important milestone for Context, but it is our ability to create and maintain successful client partnerships that is crucial to our success”, added Earles. “We look forward to serving Lone Star TPA for years to come.

About Context 4 Healthcare Inc.

Headquartered in Naperville, IL, Context 4 Healthcare, Inc develops software solutions to solve complex medical claim coding, claim editing and reimbursement challenges. Context’s software and data products enable healthcare providers and payors to reduce claim errors, denials and claim-handling costs. Privately held, Context 4 Healthcare is not affiliated with any payor or provider organization. More than 3,500 physician practices, hospitals, insurance carriers, third party administrators and managed care organizations currently use Context 4 Healthcare products. Learn more at www.context4healthcare.com .

About Lone Star TPA

Lone Star TPA distinguishes itself through experience in the self-funded industry, integrity, responsive service, integrated technological solutions and commitment to client satisfaction. Learn more at www.lonestartpa.com .

Context 4 Healthcare, Inc. fills Vice President of Sales role with Healthcare Software Sales Leader

2011-12-01T13:44:00.002-06:00

Naperville, IL, December 1, 2011 -- Context⁴ Healthcare, Inc., a leading provider of database and software solutions for reimbursement challenges in the healthcare industry, today announced that it has hired Mark J. Oman to the position of Vice President of Sales. Mr. Oman most recently led the national sales team at KnowledgeLake, Inc. of St. Louis, MO.

"Mark’s passion, dedication, leadership skills and work ethic along with his wide breadth of executive level sales experience, make him a well-qualified addition to our executive team," noted Mark Earles, Chief Executive Officer of Context 4 Healthcare. “We feel very fortunate to have him on board with us during this exciting time in the healthcare industry and during this period of growth in our business,” Earles added.

“I’m very pleased to join the Context⁴ Healthcare Family, stated Oman. “I look forward to reaching out to Context’s existing clients and other longtime contacts whom I’ve done business with in the past. It is an honor to be part of an organization that places such importance on serving its clients through innovation, devotion, and successful partnerships,” Oman added.

In addition to his service with KnowledgeLake, Mr. Oman served in a senior sales capacity with EMC Corporations’ (NYSE:EMC) Documentum Software Group and as a management team member of the Captiva Software (NASDAQ:CPTV), Healthcare Solutions Group. While at EMC|Captiva Healthcare Solutions Group, Mr. Oman’s focus was on helping healthcare organizations become more efficient within their claims processing operations.

About Context ⁴ Healthcare, Inc.

Headquartered in Naperville, IL, Context⁴Healthcare, Inc develops software solutions to solve complex medical claim coding, claim editing and reimbursement challenges. Context’s software and data products enable healthcare providers and payors to reduce claim errors, denials and claim-handling costs. Privately held, Context⁴Healthcare is not affiliated with any payor or provider organization. More than 3,500 physician practices, hospitals, insurance carriers, third party administrators and managed care organizations currently use Context⁴ Healthcare products. Learn more at www.context4healthcare.com.

Context 4 Healthcare Expands Relationship with Molina Medicaid Solutions

2011-10-05T10:48:00.004-05:00

Context’s medical crosswalk databases to support Molina’s Medicaid processing services.

Naperville, IL & Reston, VA – October 4th, 2011 – Context 4 Healthcare, Inc., a leading provider of database and software solutions for reimbursement challenges in the healthcare industry, today announced an expanded partnership with Molina Medicaid Solutions, a subsidiary of Molina Healthcare, Inc., for use of Context’s data products.

“Context has an excellent track record for data accuracy and seamless integration. Our extensive validation analysis of Context products resulted in Context being the vendor of choice for our Medicaid data needs,” notes Warren Leber from Molina’s technology development team.

“Context’s ability to meet our unique product requirements reinforced our confidence in expanding the relationship.”

“We are pleased to announce our expanded partnership with Molina in support of their business process outsourcing (BPO) needs. Our collaborative efforts on these products have culminated in the development of a robust suite of healthcare database products. We look forward to continuing our relationship with Molina and supporting the complex challenges they face,” states Mark Earles, President and CEO of Context.

“Our relationship combines Molina Medicaid Solutions’ excellence in government-sponsored health care programs together with Context’s highly reliable healthcare data solutions. We look forward to continuing our relationship with Molina and our shared commitment to accuracy in Medicaid processing services,”added Earles.

About Context 4 Healthcare Inc.

Headquartered in Naperville, Ill., Context 4 Healthcare, Inc develops software solutions to solve complex medical claims coding, claim editing and reimbursement challenges. Context’s software and data products enable healthcare providers and payors to reduce claim errors, denials and claim-handling costs. Privately held, Context 4 Healthcare is not affiliated with any payor or provider organization. More than 3,500 physician practices, hospitals, insurance carriers, third party administrators and managed care organizations currently use Context 4 Healthcare products.

About Molina Medicaid Solutions

Molina Medicaid Solutions (MMS), a subsidiary of Molina Healthcare, Inc., provides business processing and information technology administrative services to state agencies administering Medicaid and entitlement programs. MMS is uniquely positioned to help state agencies meet their health care administration and Medicaid Management Information Systems (MMIS) goals. MMS currently holds contracts with the states of Idaho, Louisiana, Maine, New Jersey and West Virginia as well as a contract to provide drug rebate administration services for the Florida Medicaid Pharmacy program. For more information about MMS, go to http://www.molinahealthcare.com/abtmolina/plans/Pages/mms.aspx.

Context4 Healthcare Professionals Participate in ONC HIT Program

2011-09-01T13:58:00.007-05:00

Context⁴ Healthcare’s Medical Director Dr. Margaret Klasa and Business Analyst Emilia Burlasz have recently been accepted into the Office of the National Coordinator‘s Health Information Technology (HIT) Program. Respectively, the completion of their six month program at Moraine Valley and NOVA , will occur early 2012 and will then be eligible for the HHS’ HIT-Pro certification.

The goal of the program is to train skilled health IT professionals who will be able to help providers implement electronic health records and achieve meaningful use.

Context⁴ Healthcare is proud to be part of this initiative and support our channel partners in EHR adoption and implementation.

Context4 Healthcare, Inc. Launches CodeLink Pro® 2011

2011-02-15T12:41:00.000-06:00

Context⁴ Healthcare, Inc. Launches CodeLink Pro^® 2011

Medical claims coding software solution drives accurate reimbursement as healthcare providers navigate the transition to the new International Classification of Diseases coding system.

Naperville, IL – February 15th, 2011 – Context⁴ Healthcare, Inc., a leading provider of software solutions for reimbursement challenges in the healthcare industry, today announced the release of CodeLink^® Pro 2011. This advanced software will play a critical role as the healthcare industry transitions to the new International Classification of Disease medical claims coding system. The new release includes a cross reference from ICD-9 to ICD-10 based on the Center for Medicare and Medicaid General Equivalency Mapping.

“During the transition from ICD-9 to ICD-10 the healthcare industry is confronting significant reimbursement, compliance and staff training issues”. “Almost every facet of the care management process will be affected by this change” notes Mark Earles, President and CEO of Context. “We are committed to providing tools that give healthcare organizations the ability to successfully navigate this transition and this is the driving force behind our new release”.

“In this new version, we leveraged our 20 years of development experience and relied heavily on customer collaboration and industry expertise in refining CodeLink^®Pro”, comments Earles. Highlights of the new release include an enhanced user interface, Medicare fees and more robust CCI information. More information about the benefits of CodeLink^® Pro 2011 can be seen at http://www.context4healthcare.com/index.php/products/code-link/.

Remaining true to its reputation as a fast and accurate coding tool built for coders; CodeLink^®Pro 2011 contains the entire listing of CPT^®, HCPCS, ICD-9-CM and ICD-10-CM codes, notes, include and exclude notes, linkage libraries and cross-reference relationships between CPT^® and ICD-9-CM / ICD-10-CM codes on a specialty-by-specialty basis.

“CodeLink is an invaluable tool that assists our office in finding CPT and ICD codes that accurately reflect procedures performed”, comments Barbara Byrne, CPC of Upstate Orthopedics located in Syracuse, NY.

“The new version of CodeLink has a great feature which allows ICD-9-CM codes to map to the new ICD-10-CM codes helping us get acclimated to the forthcoming change”.

“We look forward to continued success in developing industry leading software and database products during the coming year and remain optimistic about our ability to drive innovation in the reimbursement marketplace” commented Earles.

About Context⁴ Healthcare

Headquartered in Naperville, Ill., Context⁴ Healthcare, Inc develops software solutions to solve complex medical claims coding, claim editing and reimbursement challenges. Context’s software and data products enable healthcare providers and payors to reduce claim errors, denials and claim-handling costs. Privately held, Context⁴ Healthcare is not affiliated with any provider or payor organization. More than 3,500 physician practices, hospitals, insurance carriers, third party administrators and managed care organizations currently use Context⁴ Healthcare products. Learn more at www.context4healthcare.com.

CPT is a registered trademark of the American Medical Association.

Context4 Healthcare Is Seeking Participants for Annual CodeLink Panel Members

2010-09-21T15:43:00.004-05:00

Context4 Healthcare is seeking to add to its CodeLink product panel members and has put out a call for participants. Context is seeking physicians, nurses, medical coders and billing professionals. We are looking for panel members from all physician specialties and healthcare professionals utilizing CPT and ICD codes.

As a panel member, you will provide us with feedback on the most utilized CPT and ICD codes and the related linkages of those codes.

Participants will sign a simple contract and receive a single user license of CodeLink upon completion of our annual questionnaire and a brief phone interview. If you participate per the terms of our agreement, you'll get access to CodeLink our award winning medical coding and billing software.

If you are interested in becoming a panel member and filling out our annual questionnaire regarding the new 2011 CPT and ICD codes, please email Emilia Burlasz at emilia.burlasz@context4healthcare.com.

Context's ICD-10-CM Codes with Short & Medium Descriptions

2010-09-02T13:41:00.002-05:00

Context4 Healthcare has released ICD-10-CM codes with short and medium descriptions and is offering a special to save 10% on these data files by contacting us prior to October 1st, 2010.

BC Advantage Article - Audit proof your practice: Be prepared for RACs and MICs

2010-08-23T09:55:00.004-05:00

Context4 Healthcare's Medical Director Dr. Klasa in the current issue of BC Advantage discusses preparations for RACs and MICs in the article titled, Audit proof your practice: Be prepared for RACs and MICs.

Medicare Physician Pay Cut Fix

2010-06-25T12:23:00.004-05:00

President Obama signed the bill passed by Congress into law today that replaces the Medicare Physician pay cut of 21.2% with a pay raise of 2.2% through November.

CMS Extends Medicare Claim Hold Until June 18th

2010-06-15T10:05:00.002-05:00

CMS will continue to hold the processing of Medicare claims until June 18 to allow for additional time for Congressional action on the Physician pay cuts that went into effect on June 1.

CMS Holds June Medicare Claims

2010-06-10T09:36:00.002-05:00

CMS has instructed its claims processing contractors to hold Medicare claims submitted on or after June 1st for 10 business day with the expectation that Congress will restore the Physician Fee cut that went into effect on June 1st.

Medicare Physician Fee Cut Deadline Approaching

2010-05-24T10:44:00.003-05:00

The May 31st deadline is fast approaching again for the Medicare Physician Fee cut. The proposed fee cut of 21.3% has been delayed several times due to Congress' intervention. With Congress recessing on Monday, May 31st for Memorial Day, the deadline could be moved up to May 28. Stay tuned.

Context4 Healthcare Releases New Case Study

2010-05-13T10:54:00.004-05:00

Context4 Healthcare released a new Case Study today detailing how MedPro reduced payor denials by nearly 60% using Context4 Healthcare's ClaimsEditor.

http://www.context4healthcare.com/pdf/MedPro_Solutions_Case_Study.pdf

Context4 Healthcare Amazon Storefront Now Open!

2010-05-06T13:48:00.002-05:00

Look for us on Amazon for Physician Fees available per physician specialty.

Context4 Healthcare Will Release Short/Medium ICD-10-CM Descriptors on August 1st, 2010

2010-04-21T15:10:00.002-05:00

Context4 Healthcare will release short and medium ICD-10-CM descriptors on August 1st, 2010. http://www.context4healthcare.com/pdf/ICD_10_abbreviation_data_sheet.pdf

Official - Physician Pay Cut Delayed Until June 1, 2010

2010-04-19T09:26:00.000-05:00

President Obama signed into law the Continuing Extension Act of 2010, which delays the Medicare Physician fee cut till June 1, 2010. The law is retroactive to April 1, 2010. The Centers for Medicare & Medicaid Services (CMS) has instructed Medicare contractors to begin processing claims being previously held by CMS.

Physician Pay Cut Pushed Back Till June 1, 2010

2010-04-15T17:25:00.004-05:00

The Senate passed a legislation today that pushes back the Medicare Physician fee cuts till June 1, 2010. The House has previously passed another bill but will now have to vote on this legislation for it to be approved.

CMS Holds Physician Claims For 10 Days in April

2010-03-31T15:10:00.003-05:00

The Senate bill extending the Medicare 21% Physician pay cut till October, 2010 was not acted upon by the House and as a result the Physician pay cut is scheduled to take effect April 1, 2010. Since Congress left for a two-week recess without taking further action, CMS has stepped in by holding claims on or after April 1 for the first 10 business days buying physicians more time. If Congress does not act by April 15, CMS will start processing claims.

ICD-10 Timetable - Where Does Your Organization Stand?

2010-03-29T11:23:00.007-05:00

There is much discussion about the technological demands necessary to prepare for ICD-10-CM and ICD-10-PCS. Dr. Marge Klasa, Medical Director of Context4 Healthcare, talks about the importance of preparing early for the ICD-10-CM and ICD-10-PCS implementation in the March 29th issue of For The Record.

Context4 Healthcare, Inc. Launches ClaimsEditor® 3.0

2010-03-23T14:37:00.017-05:00

Web-based solution delivers critical resources to ensure healthcare providers protect their revenue stream while remaining compliant with rapidly changing rules and regulations

Naperville, IL - March 23, 2010 - Context4 Healthcare, Inc., a leading provider of automated technology solutions for reimbursement challenges in the healthcare industry, today announced the release of ClaimsEditor 3.0. This advanced Software as a Solution (SaaS) will play an instrumental role across the healthcare industry by ensuring that claims are properly coded, and that they are submitted in accordance with applicable Medicare, Medicaid, and third-party payer rules and regulations.

In today's uncertain economic climate with reimbursement tighter than ever and more challenges on the horizon, it is imperative that claims are coded - and therefore, paid - properly, notes Mark Earles, CEO of Context. "Providers realize how vital it is that claims fully reflect the care they deliver, are submitted once and then paid in a timely manner."

Error-ridden claims create significant headaches for provider organizations, he adds. "Simply put, problem claims are costly - on average, $25 per re-submission. This means that providers must invest additional time and staff effort in researching and reworking denials in order to be reimbursed. Ultimately, this effort erodes the practice's margins."

Improperly paid claims represent a significant and growing concern for provider organizations large and small, agrees Richelle White, CMPE, CPC of MedPro Solutions, LLC, a Pensacola, Fla. -based outsourced billing service that has used Context4 Healthcare's ClaimsEditor software since 1999. "We have been delighted with the results we've achieved with ClaimsEditor on behalf of the providers we serve. It's an effective tool that helps us stay abreast of changing payer policies so we can ensure that our clients receive the reimbursement they have earned."

Earles notes that other providers have achieved significant results with ClaimsEditor as well. "We have clients tell us their Medicare denial rate drops below 1% after they implement ClaimsEditor into their revenue cycle management process."

ClaimsEditor 3.0 relies upon the most advanced technology to streamline the coding and billing process. The new release includes new dashboard monitoring, an enhanced user interface, refined displays of CMS-1500 and UB-04 claims, stringent HIPAA compliance, and XML exporting capabilities for downloading corrected results to the practice billing system. The unique editing, claims correction, reporting and workflow management capabilities in the ClaimsEditor 3.0 deliver significant cost and compliance advantages to provider organizations large or small.

The release continues Context's successful development efforts utilizing Software as a Service (SaaS) applications. Through a secure socket layer (SSL), Context Web applications improve upon the value delivered by their progenitors - lower administrative costs, improved regulatory compliance and reduced payment delays. With ClaimsEditor 3.0, users also avoid both hardware and integration costs.

ClaimsEditor® Online Demo Video

2010-03-18T18:28:00.006-05:00

This software demo video was produced using Camtasia Studio.

Senate Vote Delays Medicare Physician Pay Cut Until October 1, 2010

2010-03-10T14:29:00.002-06:00

The Senate voted today to approve a $138 billion bill that prevents the Medicare physician fee cuts until October 1, 2010. The bill also extends Medicaid, COBRA and unemployment benefits.

CMS Transmittal Links Working

2010-03-05T06:58:00.001-06:00

The CMS Transmittal links are now working.

CMS Transmittal Links Broken

2010-03-04T10:01:00.002-06:00

Context4 Healthcare and several third party organizations have alerted CMS that their links to recent transmittals are broken. Hopefully, CMS will resolve this issue soon.

Temporary Extension Act Delays Medicare Physician Payment Cuts Till April 1, 2010

2010-03-03T11:26:00.000-06:00

In a Statement, the White House Press Secretary announced that the President signed the Temporary Extension Act of 2010 (H.R.4691) into law on March 2, 2010 which delays the scheduled 21.2 percent Medicare payment reduction for physician services until April 1, 2010.
This act also includes a provision extending the therapy cap exceptions process through March 31, 2010, which the Medicare Improvements for Patients and Providers Act of 2008 extended the exception process through December 31, 2009.

New Senate Bill Would Postpone Physician Cuts Till October 1

2010-03-02T10:26:00.001-06:00

Senate Democrats introduced another bill designed to temporarily spare physicians the 21.2% Medicare pay cut that took effect March 1 on account of partisan gridlock in Congress last week. The bill, which also extends expired unemployment benefits, subsidies for health insurance premiums, and various tax breaks, would postpone the effective date of the massive cut to October 1, 2010.

No Temporary Measure to Halt Medicare Physician Fee Reduction

2010-02-26T13:43:00.003-06:00

Senate does not move to pass a temporary measure to planned Medicare fee reductions therefore physicians will face a 21.2% pay cut on March 1, 2010.

March 1st Deadline For Medicare Physician 21.2% Fee Cut Is Almost Here....Again

2010-02-24T14:57:00.001-06:00

Another Medicare SGR (Sustained Growth Rate) physician fee schedule cut deadline is almost here. This reduction in Medicare payments for physician services continues to be repeatedly postponed at the last minute year after year. With each year's delay, the amount of the cut has grown to 21.2% for 2010. While heavy lobbying by physician groups repeatedly causes Congress to address the fee cut by delaying it, it never results in addressing the SGR legislation that fuels it. Last November, a permanent fix was passed in the House but died in the Senate.

So once again, as the January 1 deadline approached in December, a last minute two month delay (until March 1) was buried within a Defense Appropriations bill. Earlier this month, another delay (until October 1) was put into a proposed $85 billion jobs creation bill (Hiring Incentives to Restore Employment Act), but subsequent political wrangling caused this bill's scope to reduced to $15 billion and the SGR delay was removed.

This month, both the AMA, AAFP, and other physician groups have turned up their lobbying efforts again. Another delay? As AAFP president President Lori Heim, M.D stated "It is a travesty that Congress continues to kick this can down the road and doesn't address the underlying issue." Stay tuned.

ClaimsEditor RAC Audit Solution Demo Video

2010-02-23T11:13:00.004-06:00

This software demo video was produced using Camtasia Studio.

Context4 Healthcare February Newsletter Released

2010-02-04T14:03:00.001-06:00

February Context4 Healthcare Newsletter released. Discussing such topics as the ICD-10 transition, industry news, and product updates.

http://www.context4healthcare.com/pdf/Newsletter_February_2010.pdf

DME Provider Survey

2010-01-27T11:08:00.003-06:00

Context4 Healthcare would like to assess the data and technology needs of DME Providers. Please take our survey at the link below.

http://www.zoomerang.com/Survey/?p=WEB22A6797KXNH

Updated Draft 2010 ICD-10-CM Files Released By CMS and CDC

2010-01-11T09:02:00.001-06:00

A major update was released this week by both CMS (ICD-10-PCS which is the procedure portion) and the CDC (ICD-9-CM which is the diagnosis portion) updating their previous draft versions. On the diagnosis side, 1,982 new codes were added, 983 codes deleted and 1,029 codes revised. For the procedure codes, there are 2,193 new codes, 2,823 codes deleted, and 737 codes revised. While this sounds like a lot, it’s actually just a small percentage of the approximately 70,000 codes contained in each of the two groups of codes.

In addition, the GEM files (used for mapping ICD-9-CM to/from ICD-10-CM/PCS) have also been updated along with revised 2010 Coding Guidelines, Indexes, Drug Tables, Reference Manuals and updated mapping for MSDRG reimbursement. It is anticipated that these files will now continue to be updated annually until the final implementation target date of 10/1/2013.

Context4 Healthcare has the complete ICD-10-CM and ICD-10-PCS code set files (codes and complete descriptions) available in data friendly file formats.

Context4 Healthcare January DME Newsletter

2010-01-06T19:06:00.001-06:00

Context4 Healthcare January newsletter released focusing on DME:

http://www.context4healthcare.com/pdf/Newsletter_January_2010.pdf

Context4 Healthcare, Inc. Emerges as Leading Provider of Healthcare UCR Fee Databases

2010-01-05T08:10:00.009-06:00

Naperville, IL - Jan. 5, 2010 - Context4 Healthcare, Inc., (Context) which provides technology solutions for reimbursement challenges in the healthcare industry announced today that its recently revised and enhanced usual, customary and reasonable fee (UCR) databases are poised to support providers and payors as they respond to increasing scrutiny of out-of-network rates for medical claims.

"Over the past few years, the healthcare industry has experienced a great deal of turmoil related to the reliability of UCR fee databases available to help establish appropriate rates," notes Mark Earles, CEO of Context4 Healthcare. "We anticipate that this trend will only grow in upcoming months, with increased claims review and audit activity."

Because over one billion new charge points are added annually, Context products are considered to be the most reliable UCR Fee Databases on the market today. "Payors and providers now have access to a highly defensible, up-to-date source of healthcare fee data, which can assist them in setting fair and reasonable rates," he says.

Development of comprehensive UCR databases like those offered by Context addresses escalating concerns. Often, even within the same community, one provider will charge one fee for a defined service while another may charge three times that rate. "It's been difficult at times to determine what charge is most appropriate for any given service in any given geographic area," Earles points out.

Context also markets this UCR fee data to providers in the form of Custom Physician Fee Reports, as it has since 1994. Providers can access fee data specific to their speciality in any three-digit ZIP code region of the United States.

Earles notes that UCR data is essential to virtually all segments of the healthcare marketplace. "The information assists third-party administrators and payor organizations in ensuring that submitted provider charges are reasonable. In addition, providers can use the Custom Physician Fee Reports as reference material when negotiating contracts with payors or to set appropriate charges for their services. Even healthcare consultants rely upon our fee data for work with their clients."

Context4 Healthcare UCR fee methodology was developed by a team of healthcare experts, mathematicians and statisticians, and has been updated and revised bi-annually over the past 15 years using billions of actual submitted provider charges from throughout the United States. The databases have been widely used and accepted by both payors and providers in all 50 states.

"Although we strongly believe that both payors and provider organizations should use multiple reference tools to set their fee schedules and reimbursement rates, we are confident that Context provides users with highly specific and cost-effective fee management solutions that are credible and defensible," Earles adds.

CMS Releases Emergency Update to 2010 Medicare Physician Fee

2009-12-24T09:38:00.002-06:00

Conversion factor for 2010 is 36.0846.

http://www.cms.hhs.gov/transmittals/downloads/R1886CP.pdf

CMS 2010 Physician Fee Cuts Delayed

2009-12-24T09:04:00.002-06:00

The U.S. Senate approved a $636 billion military appropriations bill on Dec. 19, 2010 delaying the cuts in the Medicare physician fees until March 2010. The bill includes a provision that delayed the Centers for Medicare & Medicaid Services (CMS) plans to reduce Medicare physician payments by 21.2 percent. Physician payments are frozen at 2009 levels through Feb. 28, 2010.

RAC Region C Issues DRG Validations

2009-12-07T10:43:00.000-06:00

Connolly Healthcare, the Recovery Audit Contractor for Region C, posted new approved issues for DRG validations. These issues will be part of the complex medical review process that is being rolled out to Medicare providers.

http://www.connollyhealthcare.com/RAC/pages/approved_issues.aspx

Recent Updates Recovery Audit Contractor

2009-12-04T09:35:00.000-06:00

Recent Updates Recovery Audit Contractor: "12/02/09: CMS Announces RAC DRG Validation ADR limits for FY 2010. These limits will apply to DRG Validation only. CMS will post the limits for all other reviews at a later date."

http://www.cms.hhs.gov/RAC/Downloads/DRGvalidationADRlimitforFY2010.pdf

Context4 Healthcare Newsletter

2009-11-06T08:17:00.000-06:00

Context4 Healthcare's Newsletter focusing on UCR fees:

http://www.context4healthcare.com/pdf/Newsletter_November_December.pdf

Upcoming New or Changed UB-04 Billing Code(s) Effective 4/1/10

2009-10-28T14:54:00.000-05:00

Type of Bill Code: 077x - Federal Qualified Health Center (FQHC)

This resolves the past issue where 073x was officially defined as "Clinical-Freestanding" but Medicare had it defined as "FQHC-Federal Qualified Health Center."

Revenue Codes:

086x Magnetoencephalography (MEG)
0860 General Classification
0861 MEG

This procedure was previously billed under Revenue Code 0740 EEG (Electroencephalogram). We have a question into the NUBC as to why there are two codes for what is basically one procedure; i.e. since there are no further subdivisions in this category, why do we have 0860 and 0861?

Also upcoming for 7/1/10: Changes and deletions in the "Point of Origin for Admission or Visit" codes and some new Condition, Occurrence and Value codes.

As the Context4 Healthcare products are updated biannually for 4/1/10 and 10/1/10, these changes will be included in the 4/1/10 updated data files with the effective date of 7/1/10 noted with the new/changed codes.

New Not-For-Profit Company Database for Out-of-Network Fee Rates

2009-10-28T14:01:00.000-05:00

NY Attorney General announces reform of reimbursement system for Out-of-Network charges.

http://www.oag.state.ny.us/media_center/2009/oct/oct27a_09.html

Medicare Providers Have a New Competitor......Organized Crime

2009-10-22T14:08:00.000-05:00

CNN reports on Organized Crime targeting Medicare and Medicaid:

www.cnn.com/2009/CRIME/10/22/medicare.organized.crime/index.html?eref=igoogle_cnn

Speak Now.......

2009-10-22T09:01:00.000-05:00

NUCC seeks input on revisions to 1500 Claim Form

The National Uniform Claim Committee (NUCC) is currently seeking input on preliminary decisions it has made for potential changes to the 1500 claim form. These changes are based on the revisions in the 837 Professional Version 005010 transaction. The NUCC has made no final decisions on revising the 1500 claim form and is seeking public feedback. The comment period will end at the closed of business day on November 20, 2009.

NUCC Input Survey:
www.surveymonkey.com/s.aspx?sm=7Ll1WqF8Wj_2bECelTGGXjaQ_3d_3d

EMC Corporation Divested Assets

2009-10-15T12:34:00.000-05:00

Context 4 Healthcare: "As of July 17, 2009, EMC Corporation has divested the assets associated with its healthcare data and coding product line-including ClaimsEditor®, CodeLink®, FirstPassTM, and other healthcare knowledge products-and transferred ownership to Naperville, IL based Context4 Healthcare, Inc."