decisionhealth Newsletters, Part B News - 2012 Issue 1 (January)
Act fast or deleted G-codes could derail 2012 PQRS bonus payments
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Article Overview
This premium article focuses on a CMS claims-processing issue tied to the transition to HIPAA version 5010 and its impact on Physician Quality Reporting System (PQRS) bonus payment claims for 2011 services. It is relevant to physicians, billing staff, and coders who work with Medicare Part B claims, CMS edits, and rejected claim follow-up. The article discusses the affected G-code group, the revised CMS edit environment, the role of NOC claims, and the timing requirements for resubmission before the payment cutoff.
Why This Topic Matters
A small set of reporting claims was affected by a CMS edit change, and missed resubmission could mean lost opportunity for PQRS bonus payment credit for prior-year services. The article helps practices understand why certain claims were rejected and what general follow-up process is involved before the deadline.
Article Sections
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Physician payments
Introduces the payment impact of the CMS editing issue and the broader concern for PQRS-related claims submitted under 5010.
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The affected codes
Summarizes the scope of the CMS deletion issue, the claim-edit context, and the general characteristics of the impacted reporting codes and NOC claims.
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What you need to do
Outlines the follow-up timeline and resubmission process for previously rejected claims so they can be reconsidered for reporting purposes.
What You Will Learn
- How a CMS edit change affected certain PQRS-related claim submissions
- Why claims tied to the transition to HIPAA 5010 were rejected
- What general follow-up is involved when a claim is returned by a Medicare contractor
- How resubmission timing can affect prior-year reporting and bonus payment consideration
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Practice administrators
- Medicare claims processors
Codes Discussed
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