Certain radiation therapy codes were overlooked when the 2016, 2017 and 2018 CWF coding files were created. When brought to its attention, First Coast will override the appropriate SNF CB edits to allow for processing and payment, and will do so until the codes are correctly added to the 2016, 2017, and 2018 files in October 2018. Providers should contact customer service to request claims reprocessing.
First Coast has identified Part A therapy claims billed with Healthcare Common Procedure Coding System (HCPCS) codes 97763 and G0515 are being denied in error.
Claims for 2018 for HCPCS code J0606 billed with type of bill (TOB) 72X were denied in error. The issue was resolved February 22; First Coast will adjust affected claims.
Erroneous denials have resulted in providers receiving overpayment demand letters.
This table displays Part A and Part B processing issues that are being worked currently or have been resolved recently.
It has been brought to our attention that the activities used to initiate replacement QMB remits has resulted in overpayments on some adjustments. No provider action is required at this time.
Some providers may notice a difference in how deductible and coinsurance amounts are being displayed on the remittance advice for QMB claims. CMS reverted back to the previous display on December 8, and provided a guide to identify Medicare cost-sharing amounts on remittance advice. A permanent solution is tentatively scheduled for summer 2018. No provider action is required.
Due to the October implementation of 2017-2018 influenza vaccine payment allowances, the Centers for Medicare & Medicaid Services has directed contractors to reprocess claims that were processed on or after August 1.
First Coast Service Options Inc. (First Coast) has identified Part B radiopharmaceutical claims processed March 27 through March 28, 2018, were denied in error.
Institutional claims were inappropriately rejecting with reason code 32404 when a revenue code between 030x-031x was submitted with a laboratory HCPCS that is not a clinical diagnostic lab code. Claims that were being held to prevent inappropriate rejection are being released.
It had been discovered that the prior integrated outpatient code editor (IOCE) was incorrectly applying deductible and coinsurance to HCPCS code G0473. This article was revised to reflect that all mass adjustments have been completed.
There are no items in this section at this time.
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