Posted: February 3, 2005
The MOASC office has been in contact with NHIC regarding the Demonstration Project G Code Denials. NHIC is requesting samples of the denials. NHIC needs the ICN Number, Date of Service and Denial code. Please EMAIL pat@moasc.org or FAX (909) 985-8581 this information to the MOASC office, so that this problem can be resolved. Due to a high call volume to the MOASC office, not all phone calls regarding this issue will be returned. Please email or fax the requested information, so that this issue can be fixed. THIS INFORMATION IS NEEDED ASAP, NHIC IS WAITING!
Procedure code G0001 has been deleted for 2005. CPT 36415 has been reactivated for Medicare billing. It is a clinical laboratory service, therefore it is paid under the clinical lab fee schedule and not the physician fee schedule. The claim requires a UPIN in item 17A for the ordering physician.
NHIC/Medicare posted an updated LCD entitled Erythropoietin Analogs for
the Treatment of Anemia Unrelated to Dialysis Therapy to its website on
January 27th.
On the last page of the LCD (i.e., revision history), they note that
J0880 was deleted from the policy in error. However, according to NHIC,
J0880 was never removed from the claims processing system. Therefore,
providers should not have any denied/rejected claims due to a
processing error.
Members have raised questions regarding
NHIC/Medicare's current reimbursement for Vidaza. Specifically, the
quoted rate appears to be that of the old AWP-based formula resulting
in a reimbursement of $452. This has caused some confusion in that the
providers were under the impression that effective January 1, 2005 they
would be reimbursed for Vidaza at the ASP-based reimbursement rate of
$396.
According to a new communication from NHIC/Medicare, they have just
received the file from CMS with the new allowance and the fee for
Vidaza is $3.96 per 1 mg.
Results of recent probe reviews have revealed that certain providers are rendering and billing for more extensive evaluation and management services than are required by the patient’s presenting problem. Only the level of service required to address the presenting problem should be reported for reimbursement. Physicians’ services involving patient contact that is beyond the usual service in either an inpatient or outpatient setting may be reported as prolonged services. This service may be reported in addition to other physician services. Read this very concise billing article on the NHIC website.
