Part A

Due to a mass adjustment to correct a Part A remit issue, some QMB claims containing therapy lines denied incorrectly and are now rejected for timeliness. Claims affected are being identified and will be adjusted.

Open.

None

11/8/2018

Part A

Reason codes 30900 or 30905 are setting when an adjustment is processed and the original claim is purged or not found on history causing claims to RTP with reason code EA002. A fix is scheduled for October 1, 2018.

Open.

Resubmit a new claim after the October 1 fix is completed.

9/10/2018

Part A

Change request (CR) 10494 provides for adjustments to QMB claims processed under CR 9911; however, errors to those adjustments occurred. This article details corrections to those errors impacted claims and overpayment demand letters will be issued.

Open.

None.

9/10/2018

Part B

First Coast discovered that claims involving more than four concurrent anesthesia procedures have resulted in overpayments by allowing the base units and time units that were billed. This resulted in overpayments for claims paid from January 1, 2013, through July 20, 2018. First Coast started adjusting the claims August 30, 2018, to recover the overpayments. Providers will receive overpayment demand letters listing the impacted claim(s) to help you reconcile the payment adjustments.

Open.

If you have documentation to support that you were present at induction and you weren’t paid for the additional time unit, you may appeal the claim(s) and request First Coast to add modifier 23.

9/7/2018

Part A, Part B

The Centers for Medicare & Medicaid Services (CMS) has determined that codes J0881, J0883, J0885, J0888, and Q0138 were overlooked when the 2017 annual common working file (CWF) coding files were created. First Coast Service Options (First Coast) will override the appropriate SNF CB edits to allow for processing and payment of these codes, and will do so until the codes are correctly added to the 2017 files in January 2019.

Open.

Providers should contact customer service to request claims reprocessing.

8/10/2018

Part A

CMS has determined that a system fix implemented on July 23, 2018, caused several transfer claims to process at full diagnosis-related group (DRG) pricing. This caused overpayments in claims that meet specific criteria. First Coast will adjust the impacted claims and overpayment demand letters will be issued

Closed.

None.

11/6/2018

Part B

Part B diagnostic colonoscopy claims billed with Modifier PT and screening diagnosis codes for dates of service May 17, 2018, through July 17, 2018, were denied in error. The issue has been resolved and claims denied in error will be adjusted.

Open.

None.

8/2/2018

Part A, Part B

CMS has determined that certain codes were overlooked when the 2017 and 2018 common working file (CWF) coding files were created. First Coast will override the appropriate SNF consolidated billing (CB) edits to allow these codes to process and pay when brought to its attention.

Open.

Providers should contact customer service to request claims with dates of service on or after January 1, 2017, processed until July 2, 2018, to be reprocessed.

9/19/2018

Part A, Part B

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.

Open.

Providers should contact customer service to request claims for these CPT® codes (77770, 77771, and 77772) be reprocessed to override the SNF CB edit.

4/12/2018