In This Issue:
CMS:

• Important NPI Enrollment Information
• NPI Final Implementation
• New FDA Waived Tests Under CLIA
• RARC amd CARC Update

Noridian:

• Natriuretic Peptide Billing Correct Laboratory Coding

Medicaid:
     California Medi-Cal:

• 2008 ICD-9-CM Code Updates Delayed
• New Maternal Serum Screen Benefit

     Missouri Medicaid:

• Missouri Medicaid Renamed

  CMS

MLN Matters Number: SE0744 (PDF).
Effective Date: N/A
Implementation Date: N/A

Past Medicare Enrollment Practices May Have Contributed to the Use of Incompatible NPI/PIN Combinations

One reason a claim will reject is if the NPI and PIN used in combination on the claim does not identify the same entity. For example, the NPI in the “Billing Provider” field might be the corporation’s NPI, but the PIN used in combination with it might be the physician/practitioner’s PIN. This pairing may be the result of variations in past Medicare enrollment and PIN assignment procedures. For example, Medicare carriers may have combined the enrollment of a physician/ practitioner and his/her corporation into a single enrollment; or, a sole proprietorship may have been enrolled as a corporation because the sole proprietorship was issued an Employer Identification Number (EIN) by the IRS.

These and similar situations may require physician/practitioners who are experiencing claims rejections to ensure their Medicare enrollment information, and that of their corporations (if they are incorporated), is correct. This may require the completion of the appropriate CMS-855 Medicare Provider Enrollment Application.

If Your Claims Are Rejected

• Check Medicare Reject Report messages.
• If you use billing companies, clearinghouses, and administrative staff, check to find out if they have been contacted by Medicare carriers or A/B MACs concerning problems in matching NPI/PIN combinations to the Medicare NPI crosswalk.
• Check your information (and that of your corporation, if you formed one) in the NPPES to ensure that the NPI(s) were properly obtained. For example, if you are have a sole proprietorship, you should have an individual PIN and you should have obtained an NPI as an Individual (Entity type 1), not as an Organization (Entity type 2).
• Ensure that the NPPES data (for you and your corporation, if you formed one) are correct, and that the NPPES record(s) contains the Medicare legacy identifier(s) that was assigned to the provider (physician/practitioner or the corporation) to whom the NPPES record belongs. For example, a physician/practitioner applying for an NPI would list his/her Medicare PIN in the “Other Provider Identifiers” section of the NPI application, but would not list the PIN of the group in which he/she is a member. Medicare uses this information in building the Medicare NPI crosswalk and incorrect reporting will flow into the NPI crosswalk and cause problems down the road. To view or edit your NPPES record, go to https://nppes.cms.hhs.gov on the CMS web site. For assistance, call the NPI Enumerator at 1-800-465-3203.
• If the NPI(s) was properly obtained and the NPPES information is correct and you continue to get informational NPI edits: Ensure that your (and your corporation’s, if you formed one) Medicare enrollment information is up to date.

  CMS

Transmittal: 1349 (PDF).
Effective Date: No later than May 23, 2008
Implementation Date: January 7, 2008 and April 7, 2008

Once CMS ends its’ NPI contingency, the legacy number will NOT be permitted on any inbound electronic and outbound electronic transaction (there are exceptions to the 835 remittance advice (see CR5452)). Medicare contractors will begin rejecting claims, electronic, including direct data entry, that contain legacy provider numbers for any primary provider instead of or in addition to the NPI number. The following HIPAA transactions are also affected:

• X12N 276/277 Claim Status Inquiry/Response – (see CR5726 for details.)
• X12N 837 Coordination of Benefits (COB) – NPI only will be sent on the 837 coordination of benefits. Legacy numbers are not allowed. An exception will exist for claims that have not cleared the system by the date that CMS ends its NPI contingency plan. Such claims may contain the legacy number and, therefore, the COB transaction will also include the legacy number.

No later than May 23, 2008, providers should ensure that all HIPAA transactions sent to Medicare contractors contain only valid NPI numbers (no legacy provider numbers.)

  CMS

Transmittal: 1345 (PDF).
Effective Date: October 01, 2007
Implementation Date: October 01, 2007

New Waived Tests

  CMS

Transmittal: 1345 (PDF).
Effective Date: October 01, 2007
Implementation Date: October 01, 2007

Remittance Advice Remark Code changes
New Remark Codes

*Code MA08 text has been modified further as follows:

Deactivated Remark Codes

Health Care Claim Adjustment Reason Code Changes
New Reason Codes

Modified Reason Codes

Deactivated Reason Codes

  Noridian - Part A

News and Publications: What's New: October 18, 2007

Natriuretic Peptide test (BNP) is appropriately billed with CPT 83880. CERT errors show that providers are billing the BNP service under CPT 83516, (Immunoassay for analyte other than infectious agent antibody or infectious agent antigen, qualitative or semiquantitative; multiple step method) or CPT 83520, (immunoassay, analyte, quantitative).

Incorrect coding of services can result in overpayments with subsequent review of services from NAS or other CMS contractors.

References: CPT 2007 Professional Edition, Pub 100-4, Medicare Claims Processing Manual, Chap 4, Section 20.1

  California - Medi-cal

General Medicine: October 2007 | Bulletin 400

Medi-Cal providers are asked not to bill for services using 2008 ICD-9-CM codes until notified to do so in a future Medi-Cal Update. The Medi-Cal program has not yet adopted the 2008 updates for ICD-9-CM for Volume 1 (disease diagnoses) and Volume 3 (inpatient procedure codes) of the 2008 International Classification of Diseases, 9th Revision, Clinical Modification, 6th Edition.

  California - Medi-cal

General Medicine: October 2007 | Bulletin 400

An article published in the August 2007 Medi-Cal Update, “New Maternal Serum Screen Benefit,” stated that the benefit was effective for dates of service on or after September 1, 2007. However, the correct effective date is for dates of service on or after July 16, 2007. Providers who billed after July 16, 2007 and were denied may re-submit their claims to stay within the allowed timeliness requirements.

From the August 2007 Medi-Cal update: Effective for dates of service on or after September 1, 2007, HCPCS code S3626 (maternal serum quadruple marker screen including Alpha-Fetoprotein [AFP], estriol, human Chorionic Gonadotropin [hCG] and Inhibin A) replaces HCPCS code S3625 (maternal serum triple marker screen including Alpha-Fetoprotein [AFP], estriol and human Chorionic Gonadotropin [hCG]) as a Medi-Cal benefit. This test is called the Expanded AFP (XAFP) in California. The rate is set at $162.

  Missouri Medicaid

Provider Bulletin: August 29, 2007 (PDF).

MO HealthNet Division
The Missouri Health Improvement Act of 2007 renamed Missouri Medicaid to MO HealthNet. Effective September 1, 2007 the Department of Social Services, Division of Medical Services, will change its name to the MO HealthNet Division (MHD).

Contact Information
Effective September 1, 2007, the Division of Medical Services’ Web site address will change to www.dss.mo. gov/mhd/. All other contact information, such as mailing and street addresses, telephone numbers, and employee E-mail addresses, will remain the same.,

Contact the MO HealthNet Division (MHD)
MO HealthNet Division
615 Howerton Court
P.O. Box 6500
Jefferson City, MO 65102-6500
Telephone: 573-751-3425 – Main Number
Text Telephone: 800-735-2966
Provider Lines: 573-751-2896 or 573-635-8908
FAX: 573-751-6564