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.
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.
Thursday, September 29, 2011
In the review of a number of submitted Advance Beneficiary Notice of Noncoverage (ABNs), the CERT contractor and Noridian have noticed that many of them do not meet acceptable criteria, causing them to be invalid.
The most common of these ABN completion errors are addressed in this article.
Thursday, September 29, 2011
In response to provider queries, Noridian provides the following clarification on the use of "standing orders" for laboratory tests. Medicare generally requires that lab tests be individually ordered by the treating physician. However, in some circumstances, recurring orders for a lab test that are specific to the needs of an individual patient may be reimbursable.
Thursday, September 29, 2011
Recent Comprehensive Error Rate Testing (CERT) analysis reveals an increase in errors for diagnostic laboratory services. The CERT errors are attributed to the absence of documentation supporting the physician orders or the physician intent to have the diagnostic laboratory tests performed. Submission of appropriate documentation in a timely manner will decrease the number of errors and claims denied by the CERT contractor.
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:
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).
Monday, May 02, 2011
Noridian is providing education on understanding Local Coverage Determination (LCD) timelines relating to LCD development, reconsideration, revision, and review.
There are four distinct stages involved in processing an LCD from draft to active status:
1. The comment period;
2. The comment review period, with development of responses;
3. The notice period;
4. The active period,(i.e., the LCD is in effect).
Comment Period is a Minimum of 45 Days
NAS considers all comments from the public, and the medical community.
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.
Wednesday, September 01, 2010
Noridian Administrative Services (NAS) is instructing providers how to bill for the lab test "Decision DX GMB" using CPT code 84999. In order to assist the treating physician in determining the patient’s treatment plan, this test analyzes the genetics of a glioblastoma brain tumor.
To avoid the denial of "service not medically necessary", the following descriptive statement must be included in Item 19 of the CMS-1500 claim form or its electronic equivalent.
Friday, August 13, 2010
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.
Friday, August 13, 2010
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: