Blog

Date: 11/7/2012 2:28 PM PST



Attention Medical Providers:
The following PIP ALERT was discussed at last nights Meeting of the NJASIPP. 

This information is prepared by Massood & Bronsnick, LLC. 


NEW PIP REGULATIONS EFFECTIVE JANUARY 2013

The new PIP regulations become effective approximately January 3, 2013. The new regulations affect all medical providers but the substantial changes are to surgical centers, pain management physicians, surgeons, VNG testing, and acupuncturists. (New appeal Process goes into effect January 3, 2014)

NEW FEE SCHEDULE

The New Fee Schedule provides substantially less reimbursement and does not permit reimbursement for numerous codes (included with other procedures.) Reimbursement rates are not addressed in this memo.

A. Exhibit 1, Physicians in Surgical Centers
B. Exhibit 2, Dental fee schedule
C. Exhibit 3, Home care fee schedule
D. Exhibit 4, Ambulatory Service Fee Schedule
E. Exhibit 5, Durable Medical Equipment Fee Schedule
F. Exhibit 6, Codes Subject to Daily Maximum
G. Exhibit 7, HOSF Schedule

AMBULATORY SURGICAL CENTER

New Definition: ambulatory surgical; case means a procedure that is not minor surgery that is defined in N.J.A.C. 13:35-4A-.3. N.J.A.C. 13:35-4A-.3 states:

Codes that do not appear in Exhibit 1 are not reimbursable in an ASC.

DISCOGRAPHY

CPT Codes 62290 and 62291 are not reimbursable if performed at an ASC or an out- patient hospital. CPT 62290 and 62291 are listed in the July 2011, Exhibit 1. They have an amount for the physician, but not for a surgical center. The discography codes have been removed from the January 2012 Exhibit 1 and the October 2012 Exhibit 1. The discography codes also appear on Exhibit 7 Hospital Out-Patient with no amount. Commissioner’s October 2012 comments, page 299, states discography performed at an ASC or Out-Patient Hospitals are not entitled to reimbursement.

There are 129 medical procedures that are no longer reimbursable if performed in an ASC. They are as follows: CODE CODE
CODE
CODE
CODE
20100 20101 20102 20660 20661
20664 20931 20937 20938 20955
20974 20975 20985 21116 21365
21366 21385 21386 21395 21408
21470 21825 22220 22222 22224
22226 22318 22319 22325 22326
22327 22328 22520 22521 22522
22526 22527 22532 22533 22534
22548 22551 22552 22554 22556
22558 22585 22590 22595 22600
22610 22612 22614 22630 22632
22800 22802 22804 22808 22810
22812 22830 22840 22842 22843
22844 22845 00846 00847 22848
22849 22850 22851 22852 22855
22856 22857 23332 23350 23470
23472 24220 25246 26055 27036
27093 27095 27096 27130 27132
27227 27228 27236 27245 27447
27487 27506 27507 27511 27513
27514 27524 27535 27536 27540
61107 61154 61312 61313 63020
63030 63035 63040 63042 63044
63054 63046 63047 63048 63050
63051 63056 63057 63075 63076
63077 63078 63081 63082

Posted by Elite Physician Services | Post a Comment

Date: 11/7/2012 2:23 PM PST

 
 
Excel Surgery Center Fall Networking Event
We Own The Night
October 24, 2012
Club Aladdin_Hackensack NJ
 









































































































Posted by Elite Physician Services | 1 Comment

Copyright 2013

Home    |    Contact Us    |    High End Marketing    |    Blog

Elite Physician Services ©2011-2013