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.
This table displays Part A and Part B processing issues that are being worked currently or have been resolved recently.
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.
In light of Hurricane Irma impacting Florida, Puerto Rico, and the U.S. Virgin Islands and disaster-related claims being billed, Part A providers are unnecessarily reporting OSC 70 on SNF claims billed with the CC DR/Modifier CR, resulting in rejection. Learn what to do to avoid this rejection of disaster-related claims.
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.
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.
National coverage determination 110.21 includes new diagnosis requirements that will not be implemented in the Medicare processing systems until further notice.
National coverage detereminations (NCDs) 220.4 and 220.13 include new diagnosis requirements that will not be implemented in the Medicare processing systems until April 2, 2018.
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