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Archives for September 2013

Jeyaram & Associates’ DCH Reprocessing and Recoupment Meeting Deadline TODAY

As a service to the provider community, we are holding an open meeting at our firm and via teleconference to answer any questions providers may have regarding the reprocessing and recoupment, appeal rights, payment plans and other related issues. This meeting is free to enrolled CIS providers.

 

In-Person Meeting:
Friday, September 27, 2013
Noon – 1:00 pm
Jeyaram & Associates, P.C.
3555 Koger Boulevard
Suite 120
Duluth, GA, 30096
Phone: 678-325-3872
www.jeylaw.com

Call-In Number:
Conference Dial-in Number: (712) 432-1500
Host Access Code: 942062*
Participant Access Code: 942062#

Please RSVP  to info@jeylaw.com TODAY and indicate whether you will be attending in-person or by phone.

Free Seminar on DCH Reprocessing and Recoupment – RSVP By September 25, 2013

This week our firm has received several inquiries from CIS providers regarding DCH’s Special Reprocessing and Recoupment effort.  As a service to the provider community we are willing to hold an open meeting at our firm and via teleconference to answer any questions providers may have regarding the reprocessing and recoupment, appeal rights, payment plans and other related issues.  This meeting is free to enrolled CIS providers.

I understand that DCH is allowing re-billing of the claims under Part I Manual.  That is good news but before doing that, providers should be aware that if the re-billed claims are denied then any appeal will have to be of the new basis for denial and not the recoupment.  Providers may be waiving legal arguments to the recoupment if they re-bill.  I am not advising either way.  I just think the providers should be fully informed.

Please note that the clock has started running on any appeal or re-billing rights providers may have.

Meeting details are below:

In-Person Meeting:       

Friday, September 27, 2013

Noon – 1:00 pm

Jeyaram & Associates, P.C.

3555 Koger Boulevard

Suite 120

Duluth, GA, 30096

Phone:  678-325-3872

www.jeylaw.com

 

Call-In Number

Conference Dial-in Number: (712) 432-1500
Host Access Code: 942062*
Participant Access Code: 942062#

Please RSVP by September 25 to info@jeylaw.com and indicate whether you will be attending in-person or by phone.

CIS Claims Reprocessing – UPDATE 9/18/13

It appears that DCH will accept re-submitted claims for any claims denied during the special NCCI reprocessing.  Providers have been told to refer to DCH’s Part I Policies and Procedures Manual for details on re-billing following a mass claims reprocessing.
Part I, Section 204 (c) allows claims to be resubmitted if denied for erroneous or missing information within 3 months of the denial. Denied claims must be resubmitted with corrected information on a new claim form or be resubmitted on the third party administrator’s website at www.mmis.georgia.gov. When resubmitting a denied claim on paper more than six (6) months after the month of service, it is necessary to attach a copy of the Remittance Advice with the denial to demonstrate that the original claim had been timely submitted.
If you’ve received notice that your practice is subject to the reprocessing recoupment and need help or if you need to appeal DCH’s decisions, Jeyaram & Associates can help. Contact DJ Jeyaram at DJ@Jeylaw.com or 678.325.3872.

 

CIS Recoupments Begin – Still Time To Appeal

CIS Recoupment ClaimsThe first Special Remittance Advices (“RA”) pursuant to the Department of Community Health’s CIS Claims Reprocessing were issued this week.  Claims originally processed between November 1, 2010, through June 30, 2012, that billed specific CPT codes are subject to this special reprocessing based on the CMS National Correct Coding Initiative mandated by the Affordable Care Act.

Early reports are that the Special RA’s detailing the voided claims have been several hundred pages long with recoupments reported from $5000 to $100,000.

Some providers have indicated that DCH may be willing to enter into payment plans with providers to space-out the recoupment amount and that the Department may also allow denied claims to be re-billed with the proper CPT modifiers to allow for payment.

Section 202 of DCH’s Part I:  Policies and Procedures Manual requires that claims be received within six (6) months after the month in which service was rendered to be reimbursed unless certain exceptions are met.  It is unclear whether DCH considers the Special Reprocessing as meeting the exception requirements.  If it does not, then providers may be limited to six (6) months for re-billing claims.

If you think the Department’s determination of recoupment is incorrect, you can still appeal the determination as described in Part I of this article. It is extremely important that you satisfy all of the appeal requirements and meet all deadlines.  Failing to do so means that you waive your appeal rights and may not be able to challenge the DCH action.

If you’ve received notice that your practice is subject to the reprocessing recoupment and need help or if you need to appeal DCH’s decisions, Jeyaram & Associates can help. Contact DJ Jeyaram at DJ@Jeylaw.com or 678.325.3872.

Jeyaram & Associates Adds New Associate

Jeyaram & AssociatesPlease help us welcome the newest Jeyaram & Associate team member- Emmy Rose Naidu Jeyaram born 8/29/2013 – 8.2 lbs and 20.5 inches – to Principal DJ Jeyaram.  CONGRATS!