ACLA Lauds Deadline Delay for 'Medically Unbelievable Edits'

WASHINGTON, The American Clinical Laboratory
Association today applauded the Centers for Medicare and Medicaid Services for
allowing more time for comments on "Medically Unbelievable Edits" and
extending the implementation date of the MUE program."
G -Queue is integrated into the GTESS Claims Gateway Solution, the first
hybrid Business Process Outsourcing (BPO)/ASP model offering a complete suite
of medical claims processing applications based upon integrated , client-
customized technologies. For a demonstration of the Claims Gateway Solution,
including G-Queue, go
to http://campaigns.

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It includes workflow,
business rules, reporting, connectivity and integration with document
management.asp?src=PR .

MedLearn Joins Forces With RJ Health Systems to Launch an Online Service for Hospitals and Clinics: MedLearnDrugCodes.com

(MedLearn)
announced today the launch of an online drug coding and pricing service for
hospitals and physician practices , under an exclusive agreement with RJ Health
Systems International, LLC.
Compounding matters, there are discrepancies in how prices for drug codes are
established.com receive drug coding, pricing reimbursement information
in billable units corresponding to HCPCS and CPT drug code descriptions , which
are established, respectively, by the American Medical Association and CMS.com were ease of use and
flexibility. Also, they can search by a variety of criteria, such as by drug
reimbursement code, brand or generic drug name or NDC (National Drug Code).

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"Process transparency and production controls are key to effectively
managing outsourced partners," says Deborah M.com/mmm/webform/webform21108 .792.com
http://www.

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CMS's action comes after a concerted effort by ACLA , along with other
medical specialty and health provider groups. The web-based service is available effective May
1st.
"For many of these organizations," she continues, "maintaining a current
database of drug codes is prohibitively time-consuming and expensive.

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For more information about GTESS and its technology solutions for the
healthcare industry, please log on to http://www .com, will give
hospital pharmacies, hospital business offices and physician practices a
reliable single source for up-to-date drug coding, pricing and reimbursement
information.

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"We are very pleased to extend this service to our hospital and physician
clientele, particularly since it is the only Web-based, comprehensive coding
and pricing guide for HCPCS drug codes," states Lappen.

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"With GTESS' integrated BPM technologies, our customers get the
best of both worlds -- complete , automated control of their correspondence
processes which drive significant savings and competitive advantages and
ultimate interaction with and control of the workflow process. Vice President of Sales , at 972. We deliver higher-quality data and cleaner claims which result in
dramatic improvements in turn-around times and processing costs. ST.

Media Contact: Suzanne Lappen
(651) 292-3410
slappen@medlearn.

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G-Queue automates error-prone manual
processes by replacing them with repeatable, standardized processes that
reflect each client 's business rules and policies.com or contact John McGahey,
Sr.
This Web-based service, accessible via MedLearnDrugCodes.

A nationally-recognized authority on coding, reimbursement and compliance
issues, Medical Learning, Inc.com

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ACLA cited several concerns with the proposal , including:

* The MUEs were developed without appropriate CMS guidance as to their
purpose;
* A process to appeal the edits was lacking;
* The methodology used to develop the edits was not disclosed;
* There was insufficient stakeholder involvement in the MUEs' development .com or call MedLearn at
1-800-252-1578.

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"G-Queue
continues our tradition of providing ASP solutions to our healthcare customers
that truly maximize their resources, reduce overhead and improve overall
operability.emailserver2. Users of
MedLearnDrugCodes.

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"
Integrated into the GTESS Claims Gateway Solution(TM), G-Queue's
correspondence management module facilitates and automates correspondence
management, ensuring document security and the application of the right
resource applied to the process at the right time."
Hospitals and physician practices seeking more information about this
online service may visit MedLearnDrugCodes.medlearn.

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About GTESS Corporation
GTESS Corporation provides business process outsourcing (BPO) solutions
that help healthcare plans and benefit managers automate the management and
administration of healthcare payment systems, greatly improving process
efficiencies and productivity, while reducing errors, overpayments and costs.
GTESS provides customers with a total pre-adjudication medical claims process
system called the Claims Gateway Solution -- a suite of integrated, client-
customized modules for claims receipt, verification , data quality improvement,
duplicate claim detection, member and provider verification, PPO-Connect (TM)
network management and repricing services, claim routing and tracking, and
document management ."
MedLearnDrugCodes. The site is designed in a way that users can quickly find codes
and prices .

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ACLA was most concerned that the proposed unit-of-service edits fly in the
face of accepted medical practice. In addition, drug
wholesalers and manufacturers provide supplemental information .

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These groups raised serious
concerns about how the MUEs were developed and proposed for implementation . ACLA met with CMS
officials in late February. Other pre-defined BPM
modules will be available in the future, including a solution for pended
claims.com uses a proprietary drug code pricing methodology ,
developed by RJ Health Systems in cooperation with the Centers for Medicare +
Medicaid Services (CMS). The reimbursement amount for each drug code
correlates to the prices published for the appropriate National Drug Code
(NDC) number, as supplied to RJ Health Systems by a variety of sources,
including First Data Bank, Medi-Span and Red Book., (MedLearn) provides publications, consulting,
seminars and online learning to hospitals, physicians and other healthcare
service organizations.

Resources specifically for people who run a medical billing service.

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Alan Mertz, president of ACLA, has offered to work with CMS and its
contractor, Correct Coding Solutions, LLC, to ensure that the MUE requirements
match current medical practice and are used only as intended -- to prevent the
payment of obviously erroneous Medicare claims submissions -- rather than to
establish medical policy.GTESS . The Claims Gateway Solution uses business process
management (BPM) technologies to create new efficiencies and offer process
transparency throughout the claim process.

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ACLA subsequently asked CMS to suspend all deadlines for comments
associated with the initiative and to withdraw the MUE program . Our 'clean-claim' HIPAA-compliant
electronic data interchange (EDI) delivery systems go beyond what can be
achieved by automating parts of the process, or outsourcing operations off-
shore .

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Thus, if implemented, Medicare recipients would face negative
health care consequences.
The MUEs would impose such arbitrary limits on more than 10,000 CPT codes. G-Queue(TM) Provides Customers Real-Time Visibility and Process Improvements

RICHARDSON, Texas, GTESS Corporation, a leading
provider of Business Process Outsourcing (BPO) services to the healthcare
industry, today announced that G-Queue(TM), a Business Process Management
(BPM) solution that facilitates and automates correspondence management, is
now directly available to clients.5512, or sales@GTESS.

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GTESS G-Queue(TM) Business Process Management Solution Increases Automation Visibility and Efficiency of Claims Process

, Medical Learning, Inc. "Other important
considerations in launching MedLearnDrugCodes.

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Gage, president and CEO, GTESS
Corporation.

"Currently, there are more than 1,100 HCPCS (Healthcare Common Procedure
Coding System) and CPT (Common Procedural Terminology) codes for the
medications and vaccines administered by healthcare providers," explains
Suzanne Lappen, Publisher for Medical Learning, Inc.

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ACLA was one of the first groups to meet with high-level CMS officials to
raise concerns.

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ACLA saw the proposed standards as
contrary to the conventions established when laboratory CPT codes were
developed.
The association provided examples of likely problems.

ACLA is an association that represents local, regional and national
clinical laboratories throughout the United States. PAUL, Minn. The result can be denied or delayed reimbursements from insurers
or , in some instances, overpayments and fines levied by regulatory agencies.

medisoft coding

The organization wrote CMS Administrator Mark McClellan soon
after the proposal was first announced in January. For example , under
the initial MUE proposal, if four polyps were removed during a colonoscopy for
biopsy, the pathologist would be limited to billing for two interpretations.

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"Because GTESS has always been a business technology solutions company
singularly focused on healthcare, we are able to offer innovative solutions
that address key pain points and are easy for our clients to implement, use
and measure," said John Olsen, chief technology officer, GTESS.com.

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