This table displays Part A and Part B processing issues that are being worked currently or have been resolved recently.
First Coast has become aware of processing issues for pneumococcal and influenza vaccinations where in some instances the vaccination is not being priced, and in other instances, the vaccination is being priced; however, coinsurance is being applied in error. Affected claims will be mass adjusted.
Some hospital and long-term care hospital (LTCH) claims with discharge dates on or after October 1, 2016, may be grouped to an incorrect Medicare severity -- diagnosis related group (MS-DRG). A revision has been made and affected claims have been reprocessed.
First Coast has identifed certain Part B claims billed with modifier JW as being rejected in error as duplicate changes. Affected claims will be adjusted.
Part A services that deny in error as a result of ICD-10 diagnosis changes resulting from change request 9806 have been adjusted. [CR 9806]
Medicare Part B services that deny in error as a result of ICD-10 diagnosis changes resulting from change request 9806 were automatically adjusted after December 5 implementation. [CR 9806]
Major joint replacement (hip and knee) -- claims may have been returned to the provider (RTP) in error
Claims submitted related to local coverage determination (LCD L33618) - major joint replacement (hip and knee) between October 1, 2015 and January 28, 2016, may have been returned to the provider (RTP) in error when billed with ICD-10-CM procedure codes 0SP90JZ, 0SPB0JZ 0SPC0JZ, and 0SPD0JZ.
Application of skin substitute grafts for treatment of DFU and VLU of lower extremities -- overpayments
First Coast Service Options Inc. has identified an internal processing issue that resulted in overpayments related to the application of skin substitute grafts for treatment of diabetic foot ulcers (DFU) and venous leg ulcers (VLU) of lower extremities. Providers who received payment in error will receive a demand letter requesting the monies back.
First Coast Service Options Inc. has identified an internal processing issue that resulted in overpayments related to specimen validity testing (SVT). Providers who received payment in error will receive a demand letter requesting the monies back.
Claims submitted for computerized corneal topography (procedure code 92025) between October 1, 2015, and August 7, 2016, may have been denied in error when billed with diagnosis codes H11.811-H11-819, H18.51, H18.52, H18.53, H18.54, and H18.55.
Computed tomographic angiography of the chest, heart, and coronary arteries -- claims may have been denied in error
Claims submitted for computed tomographic angiography of the chest, heart, and coronary arteries (procedure codes 75571-75574) between October 1, 2015, and September 5, 2016, may have been denied in error when billed with diagnosis codes I35.0, I35.1, I35.2, I35.8, I48.0, I48.1, I48.2, and I48.91.
Ambulatory surgical centers (ASCs) that received an incorrect payment for Healthcare Common Procedure Coding System (HCPCS) C1822 and/or Current Procedural Terminology (CPT®) 63685 when performed with HCPCS C1822 received adjustments to previously processed claims.
Healthcare Common Procedural Coding System (HCPCS) code J7328 was overpaid in error for dates of service on or after January 1, 2016.
There are no items in this section at this time.
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