Dermatology Coding Alert

Check with your MAC to make sure you're reporting your practitioners properly.

"That should normally be a new patient visit as long as the doctors are of different specialties," said NGS's Jim Bavoso during the call. "But what we have come across more often than not is that the specialties of both members of the group are listed as the same, and that would cause this to bump. What we have found is that we have doctors that are cardiologists who may not have changed their specialty in the program."

Tip: If you come up against this issue, you can change your specialty in your contractor's system. Contact your local MAC to confirm which specialty codes your physicians enrolled under, and let the payer know if you need to change any of them.

Scenario: A patient presents to the practice, and says he has private payer insurance only, without any Medicare coverage. Because he is under the age of 65, the practice does not press him on this issue, bills the claim to the private payer, and collects the full reimbursement amount. Two years later, the private payer contacts the practice for a refund, noting that the patient actually had Medicare as primary at the time of service. The claim cannot be submitted to Medicare at that point, because Medicare's one-year payment window has passed.

Unfortunately, Bavoso told the caller, MACs are powerless to pay providers in this scenario. "You should really voice your concern to CMS to make this change," he said. "There's no change on the horizon for this issue that we can see at this point," but contractors' hands are tied until CMS formally changes the policy. Bavoso recommends that practices facing this issue should submit a written complaint to their local CMS offices.