Issue Briefs

The ISMS Division of Health Policy Research and Advocacy assists members by decoding the myriad rules and regulations that apply to the medical profession.

Our Issue Briefs, published here and available for print out, is for members only and aims to equip physicians with practical information and resources to help them run their practices.

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November 2011
A Guide for Physician Interaction with Recovery Audit Contractors
Up until now, Recovery Audit Contractor (RAC) issues have largely focused on inpatient hospital billing issues. However, the RAC for Illinois has begun to creep into issues that directly impact physicians. Anyone who submits even a single claim to a Medicare fee-for-service program is subject to claim review, audit and now RAC review. Therefore, ISMS has prepared this guide to help members. HTML | PDF

June 2011
Implementing the ICD-10-CM Diagnosis Code Data Set
On Oct. 1, 2013, physicians and their practices will be required to use the ICD-10-CM diagnosis code data set. The new data set was adopted by the Centers for Medicare & Medicaid Services (CMS) and complements initiatives of the American Recovery & Reinvestment Act of 2009. Adoption of ICD-10-CM is mandatory. HTML | PDF

April 2011
Is Your Practice Ready for HIPAA 5010?
It is suggested that practices perform a phased-in approach to HIPAA 5010 compliance culminating with the adoption of the ICD-10 diagnosis code data set. Level II (external) testing should take place in 2011, as mandated use of X12 Version 5010 begins Jan. 1, 2012. HTML | PDF

December 2010
Prevent Claims Rejections for Referred Services – Update PECOS Enrollment Records
The Centers for Medicare and Medicaid Services (CMS) published in the May 5, 2010, Federal Register its mandate that all ordering/referring providers of services for Medicare beneficiaries have current enrollment records in the Provider Enrollment Chain and Ownership System (PECOS). HTML | PDF

BONUS guide, for ISMS members only
Provider Enrollment: From Start to Not So Finished – Resource for ISMS members who use either internet-based PECOS or paper-based Medicare enrollment methods. Provides general overview of processes involved with provider enrollment and periodic maintenance of the enrollment record.

October 2010
Medicaid Claims Database and the Primary Care Case Management Program
In April 2010 the ISMS House of Delegates adopted Substitute Resolution 32 (A-10), directing ISMS to educate members about the availability of the Medicaid Claims History Database, how it can be accessed and how it may be of help to physicians treating Medicaid patients. HTML | PDF