WEBINAR
September 28,
2006
Topic: AVOIDING DUPLICATES
Questions and
Answers
Question 1: Where
can I find instructions on how to use the Interactive Voice Response (IVR) system?
Answer 1: The IVR Instructions can be found on the Publication
page of our website.
NE: http://www.medicarenhic.com/ne_prov/pubs/neivrinstructions_0806.pdf
CA : http://www.medicarenhic.com/cal_prov/pubs/caivrinstructions_0806.pdf
Question 2: What can be resubmitted?
Answer 2: Claims that
are rejected as unprocessable with the Remark Code of MA 130 can be
resubmitted. The definition attached to MA 130 is as follows: Your claim contains incomplete and/or
invalid information, and no appeal rights are afforded because the claim is
unprocessable. Please resubmit the correct information to the appropriate
fiscal intermediary or carrier. All
other denials must go through the Appeals process if you do not agree with the
denial.
Question 3: Why is the 1500 Claim Form being revised? When do I have discard the old forms?
Answer 3: CMS revised the 1500 Claim Form to
accommodate the National Provider Identifier (NPI). The revised CMS 1500 Claim
Form (08/05 version) may be used starting January 1, 2007 but will not be
mandated for use until April 2, 2007.
Question 4: Will there
be a NPI Registry like the current UPIN Registry?
Answer 4: CMS expects to publish a notice regarding its
approach to NPI data dissemination in the near future. The Dissemination Notice
will describe the information that will be available for NPIs.
Question
5: For a group of physicians,
does the group or each physician need a NPI?
Answer
5: If
the group and each physician currently have a legacy provider number, the group
and each physician will need a NPI. For
the information on the implementation of NPI and the options for obtaining a
NPI, please visit the CMS website at the attached link: http://www.cms.hhs.gov/NationalProvIdentStand/06_implementation.asp
Question
6: Is item 17A of the revised 1500
Claim Form the only field changing to accommodate NPI?
Answer
6: No.
Items 17b, 24 J and 33A have all been created on the revised form to
accommodate NPI. A picture of the revised
form and instructions for the existing and revised form can be found in our Introduction
to Medicare Guide at the following link: http://www.medicarenhic.com/providers/pubs/introguide_oct06.pdf
Question
7: When a provider is submitting
an appeal to add or change a procedure code and/or modifier does a corrected
claim need to be attached?
Answer
7: No. The first level of appeal
is called a Redetermination. When requesting a redetermination, the CMS 20027 Medicare
Redetermination Request Form should be used. The CMS 20027 does not require
a corrected claim attachment. The CMS 20027 can be found on the CMS website at
the following link: http://www.cms.hhs.gov/cmsforms/downloads/cms20027.pdf
Question
8: Will NPI apply to the UB92
Hospital Claim?
Answer
8: Yes.
However, for further assistance regarding NPI and the UB 92, please contact Medicare
Part A.
Question
9: What
is the timely filing limit for Medicare?
Answer
9: For services
rendered October 1, 2004-September 30, 2005, claims must be filed by December
31, 2006. For services rendered October
1, 2005-September 30, 2006, claims must be filed by December 31, 2007.
Question
10: What
documentation do you need to submit for proof of timely filing?
Answer
10: By
submitting the claim within the timely filing limits
Question
11: Are modifiers RT and LT only
for radiology?
Answer
11: Modifiers
RT and LT can be used for other services if appropriate
Question
12: If there are three services
by the same provider on the same day, how do we
avoid a duplicate denial? For example, 71010, 71010-76 and 71010-76
Answer
12: The
example given is the correct manner for which to bill and avoid duplicate
denials.
Question
13: If three services are done
the same day, would using units be correct?
Answer 13: Units may be used if the code descriptor
indicates each, per, etc. Modifier 76 (Repeat Procedure by Same Physician) or
77 (Repeat Procedure by Another Physician) may also apply.
Question
14: When multiple radiology
service are performed the same day, would the time of service help to avoid
duplicate denials?
Answer
14: To clarify multiple services
performed on the same day, time may be reported in item 19 or the electronic
narrative field in addition to 76 or 77.
Question
15: My physician will be updating
her info on the 855I thus required to sign up for Electronic Funds Transfer
(EFT), can she still receive the paper RA?
Answer
15: EFT
providers can still receives a Standard Paper Remittance as long as they not
receiving an Electronic Remittance Notice. If they or billing agent or clearing
house is receiving an ERA, they may have to use the Medicare Remit Easy Print
to obtain their RA.
For
more information on EFT, please see the attached MLN Matters article entitled Facilitating Your Medicare Enrollment: http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0627.pdf
For
more information on the ERA and MREP, please see the attached CMS MLN
Matters article entitled Options for Providers/Supplier
Affected by CR4376: Suppression of Standard Paper Remittance Advice http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0627.pdf
Question
16: What documentation is
required for 90808-22? When submitting an electronic claim through EDI, how do
we submit the back up?
Answer
16: No
documentation is needed to process 90808. Modifier 22 (Unusual Procedural
Services) generally only applies to surgical procedures. However, if you are
trying to indicate that Unusual Procedural Services apply to 90808, submit
modifier 22 electronically and we will send you a letter requesting the
additional documentation.
Question
17: How do you handle claims
denied for service not covered because patient is in hospice?
Answer
17: If
the provider is a hospice employee, the denial is accurate. If modifiers GV or
GW apply, you would have to appeal your denial thru the redetermination
process. Modifier GV is defined as “Attending physician is not employed or paid
under agreement by the patient’s hospice provider.” Modifier GW is defined as
“Service is not related to the hospice patient’s terminal condition”
Question
18: If a claim is denied because
the service is not paid for the diagnosis code submitted, what needs to be
done?
Related
Question: What determines whether I resubmit a claim as a
redeterminaiton, correction, or an appeal such as an incorrect dx code?
Answer
18: If after reviewing the
medical records, you determine a different diagnosis applies, you may appeal
the claim.
Question
19: The Interactive Voice System
(IVR) is very poor and responses are not correct. Why don’t you add key entry
system?
Answer
19: We
apologize for the frustration you are experiencing with the IVR. CMS requires that
all Medicare Contractors have an IVR and that providers use the IVR. The IVR is
programmed to allow for the entry of all data using touch tone in the event the
user wants to or is unable to successfully speak to the IVR. The touch tone features are outlined in the
IVR Instructions. Please see Answer 1 for the IVR Instructions.
Question
20: My doctor does hyperbaric
treatments which are done 5 days a week for up to 6 weeks. CPT 99183. Some are
denied for medical necessity but the same information applies to all services.
How should we document or submit these claims.
Answer 20: Claims may be denying for medial necessity due to the coverage criteria attached to the service. For the coverage criteria attached to Hyperbaric treatments, please see Publication 100-04, Chapter 32, and Section 80 of the CMS Internet Only Manual. Chapter 32 can be found at: http://www.cms.hhs.gov/manuals/downloads/clm104c32. If you do not agree with the denials, you may appeal the claim.
Question
21: We submit a lot of claims, 99213
with 93701 which are denied as not medically necessary. We rebill with med
notes and the claims are paid. We have not been appealing them and they are
being paid. Should they be appealed?
Answer
21: Unless you
are receiving MA130, you should not be rebilling. If 99213 or 93701 are denying for a another
reason and you do not agree with the denial, you should be appealing the claim
Question
22: Will this and other webinars
be available for listening again?
Answer
22: NHIC does not record the webinar presentation for encore
listening sessions. The slides may be downloaded at the end of a Webinar and
the Questions and Answers asked in writing and verbally at the time of the
Webinar are posted on our website in 2 weeks.
Question
23: Can we use our electronic
report showing claim was accepted for processing as timely?
Answer
23: This
may be submitted to our Written Inquiries department for consideration.
Question
24:
Is
the remit download for 1500 claims?
Answer
24: The Medicare Remit Easy Print (MREP) software may
be used by paper and electronic submitters. MREP allows off ices to view the remit
notice online. Please contact our EDI department for more information. The phone numbers to EDI may be found on our
website at the following link:
http://www.medicarenhic.com/edi/index.shtml
Question
25:
Which modifier can be used if a patient
is seen in our office and in the hospital on the same day by the same
physician?
Answer
25: If
more than one evaluation and management (E&M) face-to-face service is
provided on the same day to the same patient by the same physician or more than
on physician in the same specialty in the same group for the same or related
diagnosis, only one E&M service may be reported. Instead of billing
separately, the physician or group should select a level of service
representative of the combined visits and submit the appropriate code for that
level.
Question
26:
For multiple procedures or procedures
requiring documentation, is there a way to fax this info?
Answer
26: In CA, you may fax the information to the following numbers:
This
option is not currently available in NE.
Question
27:
Code 64613. If injections are made to 6
injections sites, how can we bill this without getting a duplicate for
injections 2-6?
Answer
27:
Since the code description attached to 64613 indicates muscle(s), one unit of
service applies regardless of muscles destructed by neurolytic agent.
10/12/2006