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Industry News: Washington

Tuesday, January 31, 2012

As of January 23, 2012, ProviderOne will automatically update professional, pharmacy, and hospital license information from an interface with the Washington State Department of Health (DOH) for all Washington State providers. The license information will be retrieved directly from the DOH on a daily basis and will update license information in ProviderOne. Shortly after the license update process begins in ProviderOne, claims will begin to deny for expired licenses.

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.

Tuesday, November 01, 2011
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).

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:

Friday, August 13, 2010

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.

Friday, August 13, 2010

On July 21, 2010, CMS notified Noridian Administrative Services (NAS) that it would consolidate the Jurisdiction 2 and Jurisdiction 3 workloads and Medicare Administrative Contractor (MAC) contracts and issue a new request for proposal (RFP).

CMS has decided to cancel the J2 A/B MAC procurement and consolidate the J2 and J3 workloads into a new RFP that will be completed in the near future.

Wednesday, March 31, 2010

What should you do if you disagree with your RAC overpayment determination? The below chart breaks down the different options providers have when disputing a RAC overpayment determination.


Retroactive to dates of services on and after October 1, 2011, the Agency has changed the following procedure codes from noncovered to covered with PA: Procedure CodeDescription
S3818BRCA1 gene anal