ASK THE CONTRACTOR TELECONFERENCE

JUNE 24, 2005

TOPIC:  BILLING TIPS

 

QUESTION:    There’s a specific code that we used to bill for radial elements (79900). CMS has directed us to use a different HCPCS code (Q3001)  from what NHIC is directing us to use ( A9699) to replace the terminated code?

                        How can we submit a request to NHIC for written directions on what code to use to replace a terminated code?

                       

Answer:            The code that we’ve instructed you to use is the A9699, I believe. Q3001 is only for ASC.

 

QUESTION:    But the A code does not represent what we’re billing.  It’s an imaging agent and we’re billing a radioactive fee.

 

Answer:            That’s the only code that is currently applicable  for that at this time.  There is no specific code at this time.

 

QUESTION:    How can I get a written clarification on this ?

 

Answer:            You can write to our Written Inquiries Department P.O. Box address .

 

QUESTION:    Is there is a street address that we can send it certified?

                       

Answer:            Yes, but generally, it goes to the PO  Box and when addressed to the attention of Laws and Guidelines you will  get the Laws and Guidelines that are applicable for that issue.

                       

QUESTION:    We have recently been getting a lot of retroactive notifications of patients’ Medicare status changing from primary to secondary. How can we deal with this?

 

                         

Answer:            There’s a possibility that we do receive the information a little bit late and you’re right, we will go back and correct our records retroactively.  It depends on the response that we’re getting on our Common Working File. There’s no way around that. 

 

QUESTION:    Are we able to refund the difference from both payers rather than refunding the full payment?

 

Answer:            No.

 

QUESTION:    So we have to refund the full payment and re-bill?

 

Answer:            Yes.

 

Question:          On the top ten billing errors , I missed # 10.

 

Answer:            #10 was Duplicate claims and services.

 

Question:          We are submitting purchased lab service through the 837 4010 format.  We are getting denials stating that the CLIA number is not valid for the services . 

 

Answer:            If it’s a purchase laboratory service, we need the CLIA number for the Lab that you purchased it from. 

 

QUESTION:    We have two more issues in regards to purchasing clinical lab test and anatomical laboratory test?

 

Answer:            You don’t purchase clinical lab.  You must have an arrangement (they’re considered referred laboratory services, not purchased.)

 

QUESTION:    What about Modifier 90 services?

 

Answer:            Modifier 90 is not applicable to anatomic lab. It is only for referred laboratory services.

 

QUESTION:    Where’s that documentation?

 

Answer:            There’s an article at our website that deals with deleted modifiers. There’s an article on our website for purchased services. If you are purchasing anatomical services, the only thing you will be completing is the field in the claim form that says “is this service purchased” You’re going to say yes, and you’re going to give us the amount.  You’re going to tell us where you purchased it from in item 32. 

 

QUESTION:    And so you don’t modify it with a 90?

 

Answer:            No.  90 is only for referred laboratory services. 

 

QUESTION:    So that would be the clinical lab ?

 

Answer:            That would be the items on the clinical lab fee schedule with the Modifier- 90.

 

QUESTION:    So is that documentation out on the website ?

 

Answer:            Yes it is. Look in the Billing Article section.  And if you can’t find it, contact our Customer Service Department and they can send it to you.

 

QUESTION:    You said earlier that the NPI is going to replace the PINs and the UPINs  and apparently the group number because you said we need to put it in Box 33 as well.  Does that mean we have to apply for a new NPI for all the various groups that we deal with?  Will each provider will have one single NPI no matter if we bill Medicare, MediCal, or commercial? Are we going to have a teleconference about NPI or is there any kind of education on NPI? 

 

Answer:            The NPI is administered by a different contractor.  It is not done by the individual Carriers.  There’s a link in our website that takes you out to information that is available on the NPI.  There’s a module out there that you can walk through that the contractor has put together.  It will be used for all insurances eventually.  Medicare will not be using it until 2007. We’re going to know who to pay by virtue of the group NPI (the number that’s assigned on the group).  There will be a cross walk from your existing number to the NPI numbers that you will be getting.  You can get all the details from the contractor in their website.

 

QUESTION:    I work for a Physical Therapy clinic.  Does the physician UPIN number need to be in item 19 as well as in item 17A?

 

Answer:            Yes it does.

 

QUESTION:    Is that for paper claims or is that electronic claims as well?

 

Answer:            That’s still required for electronic claims also.

 

QUESTION:    I heard rumors that 30-60 day certification program for physical therapy is going to be abandoned but we have no timeline and we have nothing official.  Can you shed light on that and when the local contractor might notify us?

 

Answer:            We have an article that we published on our website that gives you updates from our last release of June 6th. 

 

QUESTION:    I read through those and it didn’t sound definitive.  Do you think it’s definitive?

 

Answer:            No, things are changing daily, we’ll probably give you something that’s a little more updated.  We also plan to have a Webinar specifically on Physical Therapy probably in the next month that will be specifically include the physical therapy updates and guidelines. 

 

QUESTION:    At this time we’re leery about discontinuing our 30-60 day CERT programming.  Should we keep it in place?

 

Answer:            The Change Request (CR) does spell out what’s required every 30 days and the only thing that will probably change is the information that we may need to have submitted on the claim form.  But the Change Request (CR) does spell out what CMS’ is requiring for the certification or re-certification.

 

QUESTION:    When a patient’s physical therapy services become maintenance and no longer medically reasonable, is having the patient sign an ABN satisfactory?

 

Answer:            Yes. You can have a patient sign a statement that they are responsible for the services.

 

QUESTION:    Do they have to do that every time they are seeing the therapist?

 

Answer:            You can look at the rules out there, but you can put one out there for a specified period of time (one year).  And once that period of time has elapsed, then you would have to send us another one. 

 

QUESTION:    I noticed that a lot of people have trouble getting direct answers or definitive answers from Customer Service, is there a way we can have Michele and Cheryl’s phone number.

 

Answer:            No. You do need to work through Customer Service and if  you’re really concerned about the response you’re getting to your questions, you may ask to speak to one of the Leads or to one of the Supervisors.  Better yet put your questions in writing if you have the time to wait for definitive answers. 

 

 

QUESTION:    You did say that there was going to be a Physical Therapy Webinar update within the next month?

 

Answer:            Yes, July 27, 2005 Check our website for more details.

 

8/04/2005