Medicare Compliance & Reimbursement

October 1 might sound far away, but the new diagnoses you'll be welcoming at that point are already being developed. The ICD-9-CM Coordination and Maintenance Committee met on March 10 to discuss potential new diagnosis codes that are being considered for inclusion in this year's ICD-9 manual, and although none have been finalized, we've got a peek at what's being considered.

To read the entire list of proposed diagnoses and the committees' comments, visit http://www.cdc.gov/nchs/data/icd9/2011March_Summary_%20HA.pdf.

CMS glitch could mean you'll face consolidated billing denials. Keeping track of Medicare's consolidated billing rules can be tough as it is, but now CMS has announced it made an error that may result in erroneous denials for these services.

"It has come to the attention of CMS that, when the 2011 Annual Update of Healthcare Common Procedure Code System (HCPCS) Codes for Skilled Nursing Facility Consolidated Billing, Change Request #7159, was implemented in January 2011, a few codes were not included in the claims processing system edits," CMS noted in a recent statement. "A correction to add the codes listed below to the claims processing system edits was implemented on Monday, March 14."

The affected codes are all from CPT^®'s radiology section and are all in the 76xxx range.

If you submitted claims for the services in question before March 14, you may have seen your claims incorrectly denied. "Providers who believe they received an incorrect denial should contact their Medicare Carrier or Medicare Administrative Contractor to have the claims reopened and reprocessed," CMS notes. "Claims containing any of the codes below, processed on or after March 14, will process correctly."

To read the complete CMS statement with the list of all affected codes, visit www.cms.gov/FFSProvPartProg/EmailArchive/itemdetail.asp?filterType=none&filterByDID=0&sortByDID=2&sortOrder=ascending&itemID=CMS1246013&intNumPerPage=2000.

Have trouble deciphering the Remittance Advice (RA) that your MAC sends to you? One carrier offers a riddle to let you know how to read the document.

"There is an age-old question, 'How do you eat an elephant?' The answer to which is 'one piece at a time.' The same applies to understanding the RA," says NHIC Corp., a Part B payer in five states, in its document Understanding the Remittance Advice. NHIC deconstructs the RA to show you exactly how to understand each particular section.

For instance: Under the header "COINS," the payer isn't telling you how many coins you get back -- it's giving you information on the amount for which the patient is responsible, also known as "coinsurance." Typically, the coinsurance amount is 20 percent of the allowed amount for Part B beneficiaries, but that amount can change from year to year.

To read the entire primer on Remittance Advice, visit http://www.medicarenhic.com/providers/articles/Remittance%20Advice%20Educational%20Article.pdf.