First Coast Service Options, Inc. (First Coast), the Medicare Administrative Contractor for jurisdiction 9 (MAC J9) which includes Florida, Puerto Rico and the U.S. Virgin Islands, is aware of the issue related to the inappropriate claim denials for certain eye visit services (92012/92014), when the codes are billed with other services performed on the same date of service and appended with modifier 25. A July 2013 NCCI edit has the services 92012 or 92014 bundled into column one CPT/HCPCS codes that describe surgical procedures with a global period of 0, 10, or 90 days.
Socioeconomic News
From the American Academy of Ophthalmology
The U.S. Department of Health and Human Services has indicated that operation of the Medicare program - including physician reimbursement
First Coast Service Options Inc. (First Coast), the Medicare administrative contractor for Florida, Puerto Rico, and the U.S. Virgin Islands, is pleased to announce that the 2014 Medicare physicians fee schedule disclosures have been posted to the First Coast provider website.
On Friday morning, the U.S. House of Representatives passed an amended version of H.R. 4015 (237-182) that would repeal the flawed Sustainable Growth Rate (SGR) formula that serves as the underpinning of Medicare physician payment and provide for other Medicare payment reforms.
Insurer Offers Exemptions from Profiling Program for Ophthalmic Subspecialists. You may have been profiled incorrectly to the public by United Health Care. You need to contact them at 877.842.3210 in order to ensure that you are not being profiled inaccurately to the public. Some ophthalmic subspecialists can be excluded from UnitedHealthcare’s physician-profiling program. The seven qualifying subspecialties are: |
As millions take to the playing field this spring, the world's largest association of eye physicians and surgeons warns the public that thousands of people are blinded by sports-related eye injuries. In support of Sports Eye Safety Month this April, the Florida Society of Ophthalmology along with the American Academy of Ophthalmology reminds coaches, parents and athletes of the importance of wearing eye protection - whether for Little League or the Majors.
Recently, the FSO has received inquiries from members seeking help on denials for billing Bleph VF. Below is the language from NCCI manual, Chapter 11 for this service. This is specific for eyelids with ptosis.
NCCI, Chapter 11 states:
The Florida Society of Ophthalmology believes that transparency in health care is a good thing, and that the prevention and discovery of fraud and abuse is also important. However, the FSO does have concerns about what patients need to consider when evaluating physician information.
With the advent of summer and the glaring rays of the sun upon us, the Florida Society of Ophthalmology is reminding people of the importance of protecting eyes from damaging UV rays. The American Academy of Ophthalmology has released results of a Harris Poll, which shows that a majority of Americans are unaware that taking common drugs and having light-colored eyes can make people more vulnerable to UV exposure, a contributing factor to certain eye diseases and conditions.
First Coast Service Options Inc. (First Coast) developed its provider Internet portal application -- Secure Provider Online Tool (SPOT) -- to offer secure, online access to Medicare data, including claim status, payment information, benefits/eligibility, and data reports for members of its provider community in Florida, Puerto Rico, and the U.S. Virgin Islands.
The SPOT is also an alternative channel for the electronic submission of various forms through Secure Mail.