Iowa, Kansas, Missouri and Nebraska Providers
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Report the first EKG without a modifier. Any additional EKGs performed in the same day are reported with modifier -76 appended to the Current Procedural Terminology (CPT) code.
If a specimen is collected over a period that spans two calendar days, then the date of service must be the date that the collection period ended.
When a patient is admitted to inpatient hospital care for less than 8 hours on the same calendar date, you shall report the Initial Hospital Care using a code from CPT code range 99221-99223. In this scenario, do not use the Hospital Discharge Day Management Service CPT code 99238 or 99239.
The letterhead, if it contains a verifiable provider name and address, must also contain one of the following three elements: 1) NPI; 2) PTAN; or 3) last 5 digits of the tax identification number.
Services for billing periods after the cap has been exceeded, which are not eligible for exceptions, may be billed for denial using condition code 21.
The Medicare Part B payment allowance limits for influenza and pneumococcal vaccines are 95 percent of the average wholesale price as reflected in the published compendia except where the vaccine is furnished in a hospital outpatient department, rural health clinic, or federally qualified health center, in which cases, payments for the vaccines are based on reasonable cost.
The number of days of care charged to a beneficiary for inpatient hospital or skilled nursing facility (SNF) care services is always in units of full days. A day begins at midnight and ends 24 hours later. The midnight-to midnight method is to be used in counting days of care for Medicare reporting purposes even if the hospital or SNF uses a different definition of day for statistical or other purposes. A part of a day, including the day of admission and day on which a patient returns from leave of absence, counts as a full day. However, the day of discharge, death, or a day on which a patient begins a leave of absence is not counted as a day unless discharge or death occur on the day of admission. If admission and discharge or death occur on the same day, the day is considered a day of admission and counts as one inpatient day. Charges for ancillary services on the day of discharge or death or the day on which a patient begins a leave of absence are covered.
The DR Condition Code indicates not only that the item/service/claim was affected by the emergency/disaster, but also that the provider has met all of the requirements CMS has issued via one or more Joint Signature Memoranda (JSM)/Technical Direction Letters (TDL) regarding the emergency/disaster to which such JSM/TDL applies. The DR condition code is "disaster related" and its definition requires it to be "used to identify claims that are or may be impacted by specific payer/health plan policies related to a national or regional disaster." The DR condition code is used only for institutional billing, i.e., claims submitted by providers on an institutional paper claim form CMS-1450/UB-04 or in the electronic format ANSI ASC X12 837I. The DR condition code also may be required for any type of claim for which, at the Medicare claims processing contractor's discretion or as directed by CMS in a particular disaster or emergency, the use of the DR condition code is needed to efficiently and effectively process claims or to otherwise administer the Medicare fee-for-service program.
The answer can be found at: http://www.cms.gov/SNFConsolidatedBilling/72_2010Update.asp#TopOfPage(external link)
CR 6426 reminded you to include CAS segment related group codes, claim adjustment reason codes and associated adjustment amounts on your MSP 837 claims you send to your Medicare contractor. Medicare contractors need these adjustments to properly process your MSP claims and for Medicare to make a correct payment. This includes all adjustments made by the primary payer, which, for example, explains why the claim's billed amount was not fully paid.
Page Last Updated: Thursday, 15-Dec-2011 13:47:50 CST
