News Briefs
News Briefs
AHIMA unveils new coding standards
The American Health Information Manage-ment Association in Chicago has updated its Standards of Ethical Coding giving providers a new set of guidelines to follow when faced with coding questions. Under these new standards coders are expected:
• to support accurate, complete, and consistent coding practices;
• to adhere to ICD-9-CM coding conventions and coding guidelines approved by the American Hospital Association, the Health Care Financing Administration, and the National Center for Health Statistics;
• to only assign and report codes that are clearly and consistently supported by physician documentation;
• to consult physicians for clarification and additional documentation when there is conflicting or ambiguous data in the health record;
• to not change codes or the narratives of codes on the billing abstract so the meanings are misrepresented.
Providers seek prompt payment of medical claims
The Medical Group Management Association and 20 other health care and physicians organizations are urging Congress to require prompt payment of health insurance claims to physicians, hospitals, and other providers. "Thousands of medical group practices, hospital, physicians, and other health care providers must struggle each day just to get the insurance payments that are legally owed them," says William F. Jessee, MD, president and chief executive officer of the Englewood, CO-based association.
The coalition is urging lawmakers to include language in the managed care conference agreement to specify that a medical claim must be considered "clean" unless the claimant is notified within 10 days after initial receipt of the claim.
Reminder increases Pap smear testing
Women who receive a reminder from their doctor are more likely to schedule their annual Pap tests, according to a survey conducted by the Gallup Organization for the College of American Pathologists.
Of the 1,000 women surveyed by telephone, 54% said they receive a reminder to schedule their Pap test. By contrast, 70% of those surveyed say they receive reminders to schedule a dental exam. Among those who did not receive a reminder, 62% said they would be more likely to make an appointment if reminded.
Women who say their primary care provider is an OB/GYN were more likely to report getting a reminder about the life-saving test.
Physicians seek investigation of health plans
The Pennsylvania Medical Society and the American Medical Association have asked the Anti-Trust Division of the U.S. Department of Justice to launch an investigation into anti-competitive practices of two Pennsylvania-based health plans.
Independence Blue Cross is the dominant health plan in southeastern Pennsylvania and Highmark Inc. is the dominant plan in western Pennsylvania. The medical associations contend that the two plans have maintained market dominance by agreeing not to compete with each other.
"When a health plan controls over 50% of the market, doctors just can’t drop out of a network to redress the health plan’s anti-patient-care policies. Without sufficient competition, patients in Pennsylvania have been forced to receive their health care from a controlling insurer, which means many patients have very little choice," says Donald H. Smith, MD, president of the Pennsylvania Medical Society.
New process proposed for making coverage decisions
The Health Care Financing Administration (HCFA) has published a proposed rule setting new criteria it and local carriers would use to make certain coverage decisions.
The notice also announced that HCFA would not be adopting as final rule an earlier 1989 proposal it had made setting criteria to be used for making Medicare coverage decisions.
HCFA hopes the new rule will result in a more precise definition of what qualifies a "reasonable and necessary’’ medical service, procedure or technology eligible for Medicare coverage. Under the proposed rules, two tests would have to be met to qualify for reimbursement:
• Clinical evidence would have to exist showing medical benefits.
• The service or product must have an "added value" over existing coverage such as lower cost, improved health outcomes, or a new treatment choice such as medication in place of surgery.
The public has until June 15 to make comments on the proposal. Mail written comments (one original and three copies) to: Health Care Financing Administration, Department of Health and Human Services, Attention: HCFA-3432-NOI, P.O. Box 8016, Baltimore, MD 21244-8016.
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