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...
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: Consistent with symptoms or diagnosis of the illness or injury...
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...
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...
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...
CIGNA Government Services is proud to launch their new Part B Facebook page, dedicated to educating the Provider communities in North Carolina and Idaho. Experience the newest way to get updates from CGS! The new CIGNA Government Services Part B Facebook page will be a constant source of current and relevant information, from workshop event listings and Webinar signups, to other helpful tools...
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...
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? The discussion period offers the opportunity for the provider to...
Medicare requires that medical record entries for services provided/ordered be authenticated by the author. The method used shall be a hand written or an electronic signature. Stamp signatures are not acceptable. Patient identification, date of service, and provider of the service should be clearly identified on the submitted documentation. (Medicare Internet Only Manual 100-8, Ch 3, sect 3.4.1.1...
The purpose of this article is to provide education on medical necessity of B-Type Natriuretic Peptide (BNP) services in response to denials noted through the NAS Medical Review department. BNP is synthesized and released from the heart, and elevated levels may lend support to a diagnosis of abnormal ventricular function or hemodynamics. Used in conjunction with other clinical information, it may...
To best facilitate payment for an unlisted CPT code, please include in the claim’s narrative section what specific procedure is being linked to the unlisted code.
Any provider or organization that did not respond to the October revalidation request will have their Medicare PTANs revoked by the end of January 2010.
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...