Part A

First Coast Service Options Inc. (First Coast) has identified that claims with dates of service January 1 through February 22, 2018, for Healthcare Common Procedure Coding System (HCPCS) code J0606 (Injection, etelcalcetide, 0.1mg) billed with a 72x TOB type were denied in error.

Open.

None. This error was corrected on February 22, 2018. First Coast will adjust affected claims.

4/20/2018

Part B

First Coast Service Options Inc. (First Coast) has identified Part B radiopharmaceutical claims processed March 27 through March 28, 2018, were denied in error. This error was corrected on March 29, 2018. Claims processed on or after March 29, 2018, were adjudicated correctly.

Open.

Providers whose claims were incorrectly denied due to this error do not need to take any action. First Coast will perform adjustments to correct the error on all the affected claims.

4/12/2018

Part A

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

Part B

Some claims/adjustments for ambulance services to and from dialysis facilities and/or physician services billed with modifier 26 were denied in error. This issue was resolved on February 27, 2018.

Open.

None at this time. First Coast is waiting on guidance from CMS.

3/16/2018

Part A

Part A therapy claims with dates of service on or after January 1, 2018, billed with HCPCS codes 97763 and G0515 are being denied in error. Claims will remain in suspend status location SMUSER and SMHCPC until the issue is resolved.

Open.

None.

2/22/2018

Part A

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.

Closed.

As a workaround, FQHC and RHC providers were advised to remove claim line(s) that have been assigned reason code 32404 and resubmit the claim. Please discontinue this workaround beginning March 6, 2018.

3/6/2018

Part A, Part B

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.

Open

None. Please refer to this article on the CMS website for a guide to identify cost-sharing amounts.

1/17/2018

Part A

Deductible and coinsurance was being applied incorrectly for HCPCS G0473 (face-to-face behavioral counseling for obesity, 15 minutes) for TOB 13x for claims received on or after October 1, 2017. This was corrected with the January 2018 IOCE update release.

Closed

None. All mass adjustments have been completed.

2/15/2018

Part A, Part B

Contractors are required to implement 2017-2018 influenza vaccine payment allowances no later than October 2. Once files are updated, reprocessing will occur for claims processed on or after August 1. Medicare administrative contractors (MACs) will initiate a mass adjustment process to reprocess claims by November 1.

Closed

There is no action required by the provider.

2/2/18

Part A

Providers are reporting occurrence span code (OSC) 70 with a date range 30 days or more before the skilled nursing facility (SNF) admission date (receiving reason code 11503) on claims with condition code DR or modifier CR. Providers should not report OSC 70 on claims billed with CC DR or modifier CR.

Open

Remove the OSC 70 when reporting CC DR or modifier CR.

2/2/18