Tuesday, January 31, 2012
Codes 83890-83909 require authorization only when the genetic modifiers OA (BRCA1) or OB (BRCA2) are used. To complete your authorization request:
• Use the MN–ITS Authorization Request (278) transaction
• Bypass the edit ‘The submitted procedure does not require authorization’ by selecting ‘I would like to: Ignore errors and continue’
Tuesday, January 31, 2012
Effective for dates of service on or after 2/1/2012, report the NPI of the professional who ordered or referred the service on all claims requiring an ordering/referring professional. Use the MN–ITS Ordering/Prescribing Provider List to verify the ordering professional is enrolled with MHCP and to obtain their NPI, if not known.
Monday, January 16, 2012
When submitting appeals for A1C tests (83036) you must describe the patient's condition and include documentation, such as the A1C test results, to support the medical necessity for providing this service more frequently than once every three months. Also note that the Multi-Carrier System (MCS) begins the three-month count the day after the date of service billed. For example, if the date of service is December 15, 2011, then count day one as December 16, 2011.
Thursday, December 29, 2011
The NMP22 Bladder Check Test is used in the diagnosis and monitoring of bladder cancer. NAS will allow coverage and payment for this test when used to monitor bladder cancer between cystourethroscopy intervals.
Effective for dates of service on or after January 1, 2012, use the following codes:
• 86386 - Nuclear Matrix Protein 22(NMP22), qualitative and V10.51 - Personal history of malignant neoplasm of bladder
Thursday, December 29, 2011
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.
Thursday, December 15, 2011
The below findings for laboratory billing are reported based on the type of documentation, coding, or billing error assessed by the CERT Contractor. WPS Medicare received error findings in the following categories during the third quarter of 2011.
Insufficient Documentation - 70% of total errors
• Missing valid physician order/notes documenting intent and/or medical necessity for diagnostic services
• Illegible or missing provider signature on physician order or progress notes
Medically Unnecessary Service or Treatment - 4% of total errors
Tuesday, November 01, 2011
The NMP22 Bladder Check Test® is used in the diagnosis and monitoring of bladder cancer. NAS will allow coverage and payment for this test when used to monitor bladder cancer between cystourethroscopy intervals, effective for dates of service on or after September 19, 2011.
For claim payment, use the following codes:
• 88299 - Unlisted cytogenetic study, adding the description "NMP22" in Item 19 of the CMS-1500 form or the electronic equivalent. For Part A claims, add this notation to the remarks screen….and
Tuesday, November 01, 2011
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.
Monday, October 17, 2011
The following Comprehensive Error Rate Testing (CERT) errors occurred during the most recent reporting period within the states of Illinois, Michigan, Minnesota, and Wisconsin. The CERT Error Analysis web page details the errors found for Clinical Laboratory - Specialty 69.
Insufficient Documentation: Missing acceptable physician order (illegible signature) and progress notes (no beneficiary name, illegible signature) to support medical necessity for the laboratory tests billed.
Wednesday, September 21, 2011
The below findings are reported based on the type of documentation or coding error assessed by the CERT Contractor. WPS Medicare received error findings in the following categories during the second quarter of 2011.
Insufficient Documentation - 65% of total errors
Reasons for Errors:
• Missing valid physician order or notes documenting intent for diagnostic services
• Illegible or missing provider signature on physician order or progress notes
Medically Unnecessary Service or Treatment - 5% of total errors
Reasons for Errors:
Thursday, September 01, 2011
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.
Thursday, September 01, 2011
Noridian Administrative Services has noticed an increase in physician and physician office coding errors for Complete Blood Count (CBC), with and without differential, and other laboratory test billing.
The most common billing errors identified:
Friday, July 29, 2011
CMS has a Lab National Coverage Determination (NCD) policy for glycated hemoglobin/glycated protein, NCD 190.21. This NCD provides information on both the coverage and frequency limitations of these tests. The coverage determination is based on the diagnosis codes as listed in the NCD and the frequency shows Medicare will make payment once every three months. Any additional services must show medical necessity through the appeals process.
Monday, June 27, 2011
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.
Monday, June 27, 2011
End Stage Renal Disease (ESRD) facilities may begin to see some of their claims being adjusted to correct various issues that have been found after the implementation of the new ESRD Prospective Payment System (PPS).
Tuesday, March 29, 2011
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:
Tuesday, March 01, 2011
NAS is providing the following clarification on the use of “standing orders” for laboratory tests. While Medicare generally requires that lab tests be individually ordered by the treating physician, in some circumstances, recurring orders for a lab test that are specific to the needs of an individual patient may be reimbursable.
Monday, December 20, 2010
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.
Friday, October 01, 2010
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.
Thursday, September 02, 2010
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.