Part B Insider (Multispecialty) Coding Alert
Carrier May Have More Info On File About Your Denials
If a carrier denies your claim before payment, it is possible the only thing you will see is a standard remittance advice (RA). But you should go ahead and ask for more information.
In Transmittal 120, dated Aug. 25, the Centers for Medicare & Medicaid Services instructs the carriers to keep "more detailed information" in an accessible location so they can explain to you in more detail why they denied the claim.
For postpayment denials involving "complex review," the carriers should indicate whether they reviewed your documentation. And carriers should be careful choosing which category they place your denial in. Beneficiaries have different liabilities for statutory exclusion denials, benefit category denials or "reasonable and necessary" denials, CMS points out.
Part B Insider (Multispecialty) Coding Alert
- DRUG ADMINISTRATION:
For First IV Push After Infusion, Bill A Subsequent Code
AMA adds category for hormonal agents to drug administration codes
If you're struggling to come to [...] - PRIOR DETERMINATION:
More Certainty About High-Cost Items Could Be On Its Way
Your carrier has 45 days to decide on pricey items, but may respond more quickly
When patients [...] - REIMBURSEMENT:
Listing 'None' Or 'Other' for Medigap Insurer Will Lead To A Denial
You don't have to submit primary payors' statements with secondary claims
Medicare Remittance Notices (MRNs) are [...] - Carrier May Have More Info On File About Your Denials
If a carrier denies your claim before payment, it is possible the only thing you [...] - CODING UPDATES:
AMA Hints At Upcoming CPT Codes
CMS still wants to dispose of non-physician workpool
You could soon have [...] - New HCPCS Codes Include Low Vision Rehab, Ventricular Assist Devices
But new surgical codes won't be billable to Medicare
Watch out: You [...] - DISASTER RELIEF:
CMS Loosens Rules So That Hurricane Victims Can Get The Help They Need
Many physicians and other medical professionals are donating their time and resources to help the [...] - Part B Coding Coach:
Fee Schedule School's Back In Session
Add columns U, V and X to your stock of skills
Last month's PBI showed you [...] - Download The Fee Schedule Database With Ease
To access the Physician Fee Schedule Database, use the "search" function on CMS' home page [...] - PHYSICIAN NOTES:
Home Is Where POS 12 Is, CMS Reminds Providers
Don't bill for a home-based service using the wrong place of service
If your physician is [...]
