Industry News: Idaho

This article is to remind providers who bill Medicare Part A services that effective for dates of service beginning January 1, 2012, a brief hold will be placed on all claims. The hold will take place during the first 15 days of January 2012.

Due to updated pricing files installed into the Fiscal Intermediary Shared System (FISS), claims need to be verified for correct pricing to ensure proper payment. All claims held during this time will be released no later than January 15, 2012.

Noridian Administrative Services (NAS) will administer the Medicare Part A and Part B contract for the new jurisdiction which consists of the following states: Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming.

A MAC JF implementation page has been posted to the NAS website. The page will be the web source for Part A and Part B providers as NAS implements the new CMS JF contract. Providers should begin to refer to the site for developing information during the implementation process.

The use of the Advance Beneficiary Notice of Noncoverage (ABN) allows the appropriate liability to be transferred to the patient in the event that the services do not meet reimbursement criteria. In ABN reviews performed by the CERT and other review contractors, the most common error seen involves the "Notifier(s)" section (A) of the form. Entities who issue ABNs are collectively known as Notifiers. These entities can include physicians, non physician practitioners, providers (including laboratories), and suppliers.

Noridian hosted a CERT and Laboratory Services Ask the Contractor Teleconference (ACT) on May 17, 2011. The following are some issues identified during the CERT audit.

• Incorrect coding a urinalysis with microscopy based on protocol. There must be a physician order for the test, Medicare does not accept protocols.
• Complete drug screening tests performed without the specific type of drug mentioned. For example is the drug screen specifically for opiates or barbiturates.

BlueCross BlueShield of South Carolina1 has acquired CIGNA Government Services, LLC. While very little will change as a result of the acquisition, they are changing their name. Effective June 1, 2011, they will now be called CGSSM, LLC.

Noridian Administrative Services: Carrier/FI for Arizona, Alaska, Idaho, Oregon, Montana, North Dakota, South Dakota, Utah, Washington, Wyoming and Minnesota.
When billing for a service or procedure, select the CPT, HCPCS or drug code that accurately identifies the service or procedure performed. If no such procedure or service exists, then report the service or procedure using the appropriate unlisted procedure or service code. NAS will not correctly code unlisted codes when a valid code is available.
Correct Coding Guidelines:

Endeavor is a secure website that allows providers in AZ, MT, ND, SD, UT, and WY to verify patient eligibility, claim status inquiries, and review a single claim remittance advice. It does not cost additional fees to sign up for this service. Endeavor offers providers a web-based alternative to the processes of calling the Provider Contact Center (PCC), or the Interactive Voice Response (IVR) for information.

On August 31, 2010, Noridian Administrative Services was notified that the Recovery Audit Contractor (RAC) had closed the technical component (TC) of Lab-Pathology query. On September 8, 2010, we received the RAC closure file for this query. The file contains a large number of claims that must be processed to stop the recoupment and re-issue payment. We are aware of the impact this has on our NAS provider community and are dedicated to processing these adjustments in a timely manner. We are currently working the file and will stop recoupment and re-issue monies collected, if applicable.

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.