HCFA to Medicare carriers: no more "black box edits"
HCFA has instructed Medicare carriers to stop performing "black box edits" on codes submitted by physicians.
As part of its Correct Coding Initiative, Medicare had told its carriers to use proprietary software to check physician coding for certain combinations of codes that it has deemed inappropriate. Physicians are denied payment for part or all of services that inappropriately use these code combinations.
Typically, Medicare carriers warn physicians about the coding combinations they consider inappropriate and will flag. With black box edits, however, physicians never knew exactly which code combinations carriers would deny. HCFA argued that because the software it was using is proprietary, it could not disclose the coding combinations it was searching for without violating the copyright of the software vendor.
Starting Sept. 5, Medicare carriers were instructed to stop using the commercial software to look for inappropriate code combinations.
Medical organizations like the College fiercely opposed the use of this type of methodology and referred to it as "black box editing." The College complained that physicians must be told which code combinations are unacceptable so they can change their coding patterns and avoid being penalized. For years, ACPASIM worked to convince HCFA and Congress that "black box edits" were unfair and inappropriate.
More information about the College's position is on the Web at www.acponline.org/hpp/hbstmt.htm#proprietary.
Internist Archives Quick Links
MKSAP 16® Holiday Special: Save 10%
Use MKSAP 16 to earn MOC points, prepare for ABIM exams and assess your clinical knowledge. For a limited time save 10% when you use priority code MKPROMO! Order now.
Maintenance of Certification:
What if I Still Don't Know Where to Start?
Because the rules are complex and may apply differently depending on when you last certified, ACP has developed a MOC Navigator. This FREE tool can help you understand the impact of MOC, review requirements, guide you in selecting ways to meet the requirements, show you how to enroll, and more. Start navigating now.