Avoid Medicare claim errors and denials.
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The March 30 Interim Final Rule with Comment Period added coverage during the Public Health Emergency for audio-only telephone evaluation and management visits (CPT codes 99441, 99442, and 99443) retroactive to March 1. On April 30, a new Physician Fee Schedule was implemented increasing the payment rate for these codes. Medicare Administrative Contractors (MACs) will reprocess claims for those services that they previously denied and/or paid at the lower rate.
There are also a number of add on services (CPT codes 90785, 90833, 90836, 90838, 96160, 96161, 99354, 99355, and G0506) which Medicare may have denied during this Public Health Emergency. MACs will reprocess those claims for dates of service on or after March 1.
You do not need to do anything
Reference: MAC will Reprocess the claims – E/M
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Tag Archives: Claims
Horizon BCBSNJ Reimbursement Guidelines Changes in Outpatient Laboratory Claims
Outpatient Laboratory Claims: Referring Practitioner Required
In accordance with Centers for Medicare and Medicaid Services (CMS) guidelines, Horizon BCBSNJ requires that claims for clinical laboratory services report the referring practitioner on the claim submission. This applies to participating and non-participating providers.
Effective November 15, 2019 Horizon BCBSNJ will change the way consider and reimburse certain clinical laboratory claims that do not include information about the referring practitioner information.
Based on the guidelines of this reimbursement policy, Horizon BCBSNJ will deny outpatient claims submitted by participating or nonparticipating clinical laboratories for services provided on and after November 15, 2019 if the referring practitioner information is not included.
To avoid claim outpatient clinical laboratory claim denials, include referring practitioner information as noted below,
- In 837P transactions please include referring practitioner information in Loop 2310A
- On CMS 1500 claim forms (per the Medicare Claims Processing Manual Chapter 26 – Completing and Processing Form CMS-1500 Data Set), please include the following referring practitioner information
- Field 17. Enter a “DN” qualifier (to denote Referring Provider), and Enter the referring provider name
- Field 17b. Enter the NPI of the referring provider
To address claims denied for no referring practitioner information, clinical laboratories will have to submit a corrected claim that includes this required information. Until such time as this corrected claim information can be submitted and processed, members cannot be held liable for services related to these claim denials.
Source: https://www.horizonblue.com/providers/news/news-legal-notices/reimbursement-policy-implementation-outpatient-laboratory-claims-referring-practitioner-required
MAC will Reprocess the claims – Telephone E&M Visits
The March 30 Interim Final Rule with Comment Period added coverage during the Public Health Emergency for audio-only telephone evaluation and management visits (CPT codes 99441, 99442, and 99443) retroactive to March 1. On April 30, a new Physician Fee Schedule was implemented increasing the payment rate for these codes. Medicare Administrative Contractors (MACs) will reprocess claims for those services that they previously denied and/or paid at the lower rate.
There are also a number of add on services (CPT codes 90785, 90833, 90836, 90838, 96160, 96161, 99354, 99355, and G0506) which Medicare may have denied during this Public Health Emergency. MACs will reprocess those claims for dates of service on or after March 1.
You do not need to do anything
Reference: MAC will Reprocess the claims – E/M
Clean Chiropractic Claims Require Coders to Know Where It’s “AT”
Ever since the publication of the Office of Inspector General’s (OIG’s) portfolio “Medicare Needs Better Controls to Prevent Fraud, Waste, and Abuse Related to Chiropractic Services” in February 2018, chiropractic services have been on the OIG’s radar for improper payments. So, what can you do to avoid the OIG’s scrutiny and keep the auditors from […]
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Clean Chiropractic Claims Require Coders to Know Where It’s “AT”
Ever since the publication of the Office of Inspector General’s (OIG’s) portfolio “Medicare Needs Better Controls to Prevent Fraud, Waste, and Abuse Related to Chiropractic Services” in February 2018, chiropractic services have been on the OIG’s radar for improper payments. So, what can you do to avoid the OIG’s scrutiny and keep the auditors from […]
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Waive Cost Sharing on Applicable Claims Using Modifier CS
The implementation of the Families First Coronavirus Response Act waives cost-sharing (coinsurance and deductibles) for COVID-19 testing-related services. The Act is a bit convoluted (as most Acts are) so the Centers for Medicare & Medicaid Services (CMS) breaks down what it all means for Medicare Part B claims in a special edition of MLN Connects, released […]
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Check Your FESS Claims for Improper Payment Adjustments
MACs may be applying the multiple endoscopy rule incorrectly. In the 2020 Medicare Physician Fee Schedule (MPFS) Final Rule, the Centers for Medicare & Medicaid Services (CMS) finalized the proposal to apply the special rule for multiple endoscopic procedures to the family of functional endoscopic sinus surgery (FESS) codes. Real-world Scenario Practices are now getting […]
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iQIES Problems Derail Some PDGM Claims
The clock is ticking for OASIS matching edits to begin returning claims. Another week has gone by under the Patient-Driven Groupings Model with no solutions announced for OASIS submission problems with the new iQIES system. Why Are OASIS Files Being Rejected? At press time, 94 percent of home health agencies (HHAs) had gotten onto the […]
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Prevent Medicare Claims Denials in 2020
Medicare has been issuing beneficiaries new member cards with Medicare Beneficiary Identifiers (MBI) in place of Social Security Numbers (SSNs) for more than two years. 2019 was a phase-in period when Medicare would accept either a beneficiary’s Social Security Number or their new MBI on claims. Starting Jan. 1, 2020, CMS will reject any Medicare […]
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Lenox Hill Hospital Pays $12.3 Million Settlement For Submitting Fraudulent Medicare Claims
The US Attorney for Manhattan, New York, and a Special Agent for the OIG’s New York Regional Office, announced today that the US Federal Government has settled a civil fraud suit against Lenox Hill (a Manhattan Hospital) and its corporate parent Northwell. The Government’s complaint alleges that the two Defendants violated the False Claims Act by knowingly and fraudulently billing Medicare for healthcare services that didn’t comply with Medicare law.
The post Lenox Hill Hospital Pays $ 12.3 Million Settlement For Submitting Fraudulent Medicare Claims appeared first on The Coding Network.