CMS requires that any Medicare service provided or ordered must be authenticated by the author -- the one who provided or ordered that service. Authentication may be accomplished through the provision of a hand-written or an electronic signature; however, stamp signatures are unacceptable. In addition, any documentation submitted to substantiate the medical necessity for a service billed to...
WPS Medicare has noted an increase in the number of Comprehensive Error Rate Testing (CERT) errors related to CPT codes 85025 and 85027. Based on review of documentation, either the test administered or the physician order did not support the service billed to Medicare. These codes are defined in CPT® 2009 as: 85025 - Complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and...
5010 is an electronic data interchange version of the ANSI X12 formats for all HIPAA financial and administrative transactions for claims, remittance advice, eligibility, and claim status query and response transaction, plan enrollment, and referral authorization transactions. 5010 is for all covered entities (health care provider that conducts certain electronic transactions, clearinghouse or...
Noridian Administrative Services, LLC- Carrier/FI for Arizona, Alaska, Idaho, Oregon, Montana, North Dakota, South Dakota, Utah, Washington, Wyoming and Minnesota. This article corrects a previous article published in Medicare B News Issue 256 on August 26, 2009. CPT 80050 is a non-covered panel and should not have been included in the “Organ or Disease Oriented Panels” chart. Any automated or...
Cahaba Government Benefit Administrators®, LLC -MAC for Jurisdiction 10, which includes Alabama, Georgia and Tennessee Modifier 59 is an NCCI-associated modifier that is often used incorrectly. This modifier should be used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. This may represent a different session or patient...
TrailBlazer Health Enterprises® - Carrier/FI for Colorado, New Mexico, Oklahoma, Texas and Virginia. Due to the recent increase in the number of errors identified during the Comprehensive Error Rate Testing (CERT) contractor audit for the lack of physician orders for diagnostic tests, TrailBlazer recommends that providers sign all orders for testing and/or progress notes showing the intent for...
Noridian Administrative Services, LLC- Carrier/FI for Arizona, Alaska, Idaho, Oregon, Montana, North Dakota, South Dakota, Utah, Washington, Wyoming and Minnesota. Noridian Administrative Services, LLC (NAS) has noticed an increase of incorrect coding for Complete Blood Count (CBC) and Urinalysis (UA) laboratory services. Recent Comprehensive Error Rate Testing (CERT) analysis indicates...
The Medicare, Medicaid, and SCHIP Extension Act of 2007 made several changes affecting payments to physicians. One such change provides for a 0.5 percent increase to the physician fee schedule conversion factor for January 1 through June 30, 2008, instead of the -10.1 percent that was scheduled to take place. As of July 1, 2008, the -10.1 percent update to the physician fee schedule will go into...
As of October 29, 2007 all Medicare contractors have lifted the bypass logic and are editing against the Medicare crosswalk. As a result, claims that include non-matching NPIs and legacy identifiers are now rejecting. The following reviews the next set of dates which are crucial for compliance with the NPI regulations. New Codes Date Implementation...
The following contracts have been awarded so far: Highmark Medicare Services On October 24, 2007, CMS awarded the J12 A/B MAC contract to Highmark Medicare Services, Inc (HMS). As the J12 A/B MAC, HMS will immediately begin implementation activities and will assume full responsibility for the work no later than September 2008. Visit their web site. Noridian Administrative...
The following is the latest update of Remittance Advice Remark Codes used in electronic and paper remittance advice and Claim Adjustment Reason Codes used in electronic and paper remittance advice and coordination of benefits (COB) claim transactions. Effective Date: January 1, 2008 New Codes Code Current Narrative Comment N388...
Effective March 1, 200. WPS is taking the next step towards full implementation of the NPI in Medicare. Medicare Part B claims must include an NPI in the primary fields on the claim (i.e., the billing, pay-to, and rendering fields). You may continue to submit NPI/legacy pairs in these fields or submit only your NPI on the claim. You may not submit claims containing only a legacy identifier in the...
National Government Services, Inc. for New York and New Jersey Medicare Part B will retire the Local Coverage Determinations (LCD) listed below, effective May 31, 2007. Based on analysis of their effectiveness, these LCDs are no longer useful for prepay, postpay, or educational purposes. Retired Local Coverage Determinations (LCD) May 31, 2007 LCD Title NY LCD Number NJ...
Medicare Secondary Payer (MSP) voluntary refund checks submitted by providers to NHIC are included with all other checks received at NHIC. As such, research is required to identify those checks as MSP voluntary refunds. In order to improve the timeliness for application of the monies returned and provide improved service to the provider community, please use the following guidelines when sending...
Medicare Secondary Payer (MSP) is the term used by Medicare when it is not responsible for paying a claim first. When Medicare began on July 1, 1966, it was the primary payer for all beneficiaries, except for those who received benefits from the Federal Black Lung Program, Workers’ Compensation (WC), and those that receive all covered health care services through the Veterans Health...
CR4031 amends payment files issued to Medicare carriers and intermediaries based upon the November 15, 2004, Final Rules for the 2005 Medicare Physician Fee Schedule Database. The changes to the fee schedule involve numerous CPT/HCPCS codes. While many of these changes are effective retroactive to January 1, 2005, please note that your carrier/FI will not reprocess claims already processed,...
Revision to the Centers for Medicare...
Part B travel allowance for 2005 is increased to $0.855 per mile (HCPCS code P9603) and $8.55 per flat rate trip basis (P9604), under a correction announced by Medicare and retroactive to January 01. Medicare contractors aren't required to adjust travel fees already paid, but must do so for claims that clinical laboratories bring to their attention. The fee increase results from an...
Empire Medicare New York is transitioning to the Multi-Carrier System (MCS) on May 02, 2005. As a result, the Companion Guide for HIPAA-compliant 837 X12 4010A1 claim transactions is being updated. In addition, the new MCS Edit Report will replace the Medicare Part B VMS Submitter Report (commonly known as the validation report) for all electronic claim submitters. One of the major...
Empire Medicare New York has updated LCD 84066 / Phosphatase, acid, prostatic effective 04/15/2005 to include the following ICD-9 Codes: 199.0, 199.1, 600.01, 600.10, 600.11, 600.21, 600.90, 600.91