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OVA1 or ROMA for Ovarian Cancer Screening: updated

Mon, 2013-04-22 09:53

For dates of service prior to January  1, 2013, submit CPT code 84999 for OVA 1 and ROMA testing for ovarian cancer.  CGS will review the supporting documentation for individual claims to determine if the medical need is established. For dates of service on or after January 1, 2013, submit these services using the established CPT codes for OVA1 and ROMA testing (CPT codes 81500 and 81503).  CMS has established that these codes are not payable by Medicare, effective for dates of service on or after January 1, 2013.

CPT Code 88305: Results of Progressive Corrective Action (PCA)

Fri, 2013-03-29 10:04

CGS conducted probe reviews on providers that submitted claims for CPT code 88305 Level IV-Surgical pathology and microscopic examination; providers were selected for these reviews based on their allowed services and charges. The overall error rate for Kentucky exceeded 21%, and the overall Ohio error rate exceeded 56.39%.

Based on the review of 200 claims, CGS identified the following issues.

CHANGE NOTIFICATION TO REIMBURSEMENT POLICIES

Thu, 2013-02-28 09:55

For claims with for dates of service on or after May 20, 2013, Travel allowance services for collection of a Lab Specimen reported with HCPCS codes P9603 and P9604 are not eligible for separate reimbursement even when reported with modifier 59. The Laboratory and Venipuncture Services reimbursement policy will also be updated to reflect this change.

OVA1 or ROMA for Ovarian Cancer Screening

Thu, 2012-10-25 12:09

OVA1 has been FDA cleared for use in women who meet specific criteria. OVA1 is not intended to be a screening test or to determine whether a patient should proceed to surgery.  It can, however, be used as a tool by the patient’s primary physician to decide if the referral for treatment of a mass should go to a gynecologist or a gyn-oncologist. Submit CPT code 84999 for OVA 1 and ROMA testing for ovarian cancer.  CGS will review the supporting documentation for individual claims to determine if the medical need is established.

Correcting the Billing Provider's Information on Claims

Thu, 2012-09-27 10:41

CMS addressed claims reprocessing requirements for claims that were affected by the 2010 Medicare Physician Fee Schedule (MPFS) update. These adjustments were required as a result of the Patient Protection and Affordable Care Act (ACA), which retroactively adjusted some Medicare payments dating back to date of service January 1, 2010. As part of this adjustment action, CGS has identified internal system edits regarding corrections of claims specifically tied to the billing provider's NPI number.

National Government Services Launches Enhanced Medical Policy Center Search Function

Fri, 2010-05-28 08:04

National Government Services has finalized several elements of its enhanced Medical Policy Center (MPC) search function on the NGSMedicare.com Web site. The following improvements are effective immediately:

Section 935 Recoupment Basics

Fri, 2010-05-28 08:01
Recoupment is the act of recovery by a Medicare contractor—such as National Government Services or by a recovery audit contractor (RAC)—of any outstanding Medicare debt by reducing present or future Medicare remittance advice payments and applying the amount withheld to the indebtedness. It applies to the recovery of funds for all Medicare Part A and Medicare Part B claims for which a demand letter is issued.

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