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Same Day, Multiple Units Billing Reminder

Tue, 2012-11-27 09:50

Medicaid billers are reminded to use a single claim line per CPT code, and to provide a total number of reported units on that line. Claims with multiple units of the same procedure code for the same recipient, on the same date of service, by the same provider must be billed on one claim line with the total number of units reported. The criteria for same provider (billing or rendering) is based on provider type. Claims submitted with multiple claim lines, whether on a single claim or multiple claim forms, are considered duplicates for claims processing purposes will be denied.

New Medicaid Enrollment Requirements: Referring, Ordering, and Prescribing Providers affected

Sun, 2011-06-26 17:00

The Patient Protection and Affordable Care Act of 2010 requires that physicians and other practitioners who prescribe or order services for Medicaid recipients, or who refer Medicaid recipients to other providers must be enrolled as participating Medicaid providers.

42 C.F.R.455.410 (b) states:

"The State Medicaid agency must require all ordering or referring physicians or other professionals providing services under the State plan or under a waiver of the plan to be enrolled as participating providers."

New Medicaid Enrollment Requirements: Referring, Ordering, and Prescribing Providers affected

Sun, 2011-06-26 17:00

The Patient Protection and Affordable Care Act of 2010 requires that physicians and other practitioners who prescribe or order services for Medicaid recipients, or who refer Medicaid recipients to other providers must be enrolled as participating Medicaid providers.

42 C.F.R.455.410 (b) states:

"The State Medicaid agency must require all ordering or referring physicians or other professionals providing services under the State plan or under a waiver of the plan to be enrolled as participating providers."

Standing Orders

Wed, 2010-09-01 09:24

The use of the term, "standing orders," in Medicare is problematic due to its diverse meanings and usages, not all of which are covered by Medicare. "Standing orders" may be understood to describe both recurring orders specific to the care of an individual patient and as routine orders for services delivered to a population of patients. Standing orders may be utilized for non-laboratory services if they met the definition of recurring orders, not routine orders. Standing orders may be used for laboratory tests ONLY if several conditions are met. Read the complete update.

Documentation Attestation Form: Medicare Part B

Fri, 2010-08-13 11:42

Recent Comprehensive Error Rate Testing (CERT) findings show an increase in denials and recoupment due to the lack of a legible identifier for services provided and/or ordered in medical record documentation review. NAS is therefore reprinting information for the NAS provider community. The emphasis of this information is to educate providers on the necessity of having legible and complete provider signatures affixed to medical documentation.

Billing Prothrombin Time (PT): Medicare Part A

Fri, 2010-08-13 11:57

Recent Comprehensive Error Rate Testing (CERT) analysis indicates increased errors when billing Prothrombin Time (PT). The PT must meet medical necessity criteria, even when done as part of a coagulation clinic or “incident to” other services.
Medicare pays for services based on medical necessity. These tests must be:

Correct Billing of Urinalysis: Medicare Part A

Fri, 2010-08-13 11:53

Recent Comprehensive Error Rate Testing (CERT) analysis indicates increased errors when billing Urinalysis automated (UA), with microscopy CPT® 81001. Upon medical review of the documentation submitted, the physician written order indicates UA test but does not indicate microscopy. Appropriate billing based on testing ordered is CPT® 81003. Submitting a claim for diagnostic tests without the physician approval is a coding error.

NAS will consolidate Jurisdiction 2 and Jurisdiction 3

Fri, 2010-08-13 11:51

On July 21, 2010, CMS notified Noridian Administrative Services (NAS) that it would consolidate the Jurisdiction 2 and Jurisdiction 3 workloads and Medicare Administrative Contractor (MAC) contracts and issue a new request for proposal (RFP).

CMS has decided to cancel the J2 A/B MAC procurement and consolidate the J2 and J3 workloads into a new RFP that will be completed in the near future.

Recovery Audit Contractor Provider Options Table

Thu, 2010-04-01 15:42

What should you do if you disagree with your RAC overpayment determination? The below chart breaks down the different options providers have when disputing a RAC overpayment determination.

Provider Options - RAC Overpayment Determination

Discussion Period Rebuttal Redetermination
Which option should I use?

Recovery Audit Contractor Information

Thu, 2010-04-01 15:42

Recovery Audit Contractors (RACs) are companies that contract with CMS to find improper payments (both overpayments and underpayments) that may have been made to Medicare providers. Section 302 of the Tax Relief and Health Care Act of 2006 made the RAC Program permanent.

RACs review claims on a post payment basis. There are two types of reviews conducted by RACs:

  • Automated (no medical record needed)
  • Complex (medical record required)

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