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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.

Discontinuation of Paper Claims Submission

Mon, 2013-01-28 14:35

Ohio Administrative Code (OAC) rule 5101:3-1-19 is being amended to comply with Section 5111.052 of the Ohio Revised Code which requires that as of January 1, 2013, Medicaid providers use only electronic claims submission processes to submit claims to the Ohio Department of Job & Family Services. Prior to this change, hard copy paper claims were allowed for certain claim submissions.

Improper Payments to Providers for Incarcerated Beneficiaries

Wed, 2012-12-19 14:25

The Office of Inspector General (OIG) of the Department of Health and Human Services advised in the 2013 OIG Work Plan that they would be reviewing Medicare payments for Incarcerated Beneficiaries. Audits conducted by the OIG have resulted in overpayments to providers across the country, including those serviced by National Government Services. As a result, CMS has charged National Government Services to begin the process of recouping identified overpayments. The first series of overpayment adjustments have generated. Overpayment letters will begin to be mailed on Monday, December 10.

Payments for Alien Beneficiaries Unlawfully Present in the United States on the Dates of Service

Wed, 2012-12-19 14:22

The Office of Inspector General (OIG) of the Department of Health and Human Services advised in the 2013 OIG Work Plan that they would be reviewing payments for Alien Beneficiaries Unlawfully present in the United States. Audits conducted by the OIG have resulted in overpayments to providers across the country, including those serviced by National Government Services. As a result, CMS has charged National Government Services to begin the process of recouping identified overpayments. The first series of overpayment adjustments have generated.

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.

Overpayment Letters: Look for Blue Envelopes

Thu, 2012-08-30 17:00

Beginning August 13, 2012, CGS will send all overpayment letters (demand letters) in light blue envelopes. Requests for repayment of Medicare funds are time-sensitive, and they hope that this change in envelope color will help you quickly and easily identify these requests.

ï CGS uses the Healthcare Integrated General Ledger Accounting System (HIGLAS). HIGLAS is the standard accounting and payment system for Medicare and Medicaid, and all demand letters from CGS are issued through HIGLAS

Billing for Drug Screens: G0431

Tue, 2012-06-26 17:00

Effective 04/01/2010 CMS implemented a new HCPCS code for drug screening; replacing the 80101 CPT code for Medicare use. Cigna Government Services (CGS) claim denial analysis and appeals data indicate an ongoing issue with the use of this code. Beginning in calendar year 2011, G0431 is defined as: drug screen, qualitative: multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter.

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