Industry News: North Dakota

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.

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

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.

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.

In another key step to further states’ role in developing a robust U.S. health information technology (HIT) infrastructure, CMS announced today additional federal matching funds for certain state planning activities necessary to implement the electronic health record (EHR) incentive program established by the American Recovery and Reinvestment Act of 2009 (Recovery Act).

The releases highlight awards (totaling $6.91 million) of 90 percent federal matching funds for planning activities for the Recovery Act’s Medicare and Medicaid Electronic Health Record Incentives Programs.

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.

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 physician approval is a coding error.