General
These are currently the most asked questions at our Provider Contact Center. Please read the Q&A below to see if we can help you with your inquiry.
- My claim was rejected stating the outpatient therapy limitation was over applied. What do I need to do to receive payment for these services?
- My claim was not paid because I submitted the line items as non-covered in error. Do I need to appeal this claim so Medicare will consider payment?
- If we want to bill a service for which there is an LCD, does every diagnosis code on the claim have to be on the covered diagnosis list on the LCD in order for the claim to be considered for payment?
- We discharged a patient to home after an inpatient stay. The patient came back to the hospital later that day for a colonoscopy. Can we bill these charges separately as an outpatient or do they need to be included on the inpatient claim?
- The beneficiary's name in FISS does not match what I verified in the CWF. How does the name get corrected in FISS to match CWF?
- How do I bill a no-payment claim to receive a rejection for other insurance?
- How can I determine if I billed the correct patient status code on my claim?
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When the outpatient therapy limitation is over applied, you would need to append the -KX modifier to each line if appropriate. More information on the -KX modifier is located in the CMS IOM Publication 100-4, Chapter 5, section 10.2.C.1.
(Question based on August 2008 top written inquiries)
Date Posted: 10/15/2008, Date Reviewed/Revised: 10/28/2008
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No, if you submitted your charge as non-covered in error, you can do an adjustment to the claim. You will need to delete the non-covered line and rekey as covered. Appeals should only be requested on medically denied charges.
(Question based on August 2008 top written inquiries)
Date Posted: 10/15/2008, Date Reviewed/Revised: 10/28/2008
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No, you would only be required to have one diagnosis code on the claim to support the medical necessity of the service being billed unless there is an asterisk (*) next to the diagnosis code. On an LCD, an asterisk next to the diagnosis code means you must use an additional code to clarify the reason or diagnosis for the services.
(Question based on July 2008 top written inquiries)
Date Posted: 09/11/2008, Date Reviewed/Revised: 10/28/2008
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If the patient was truly discharged from the facility and then received outpatient services, those services would be billed on a separate outpatient claim. You can reference CMS IOM Publication 100-04, chapter 3, section 40.3.
(Question based on July 2008 top written inquiries)
Date Posted: 09/11/2008, Date Reviewed/Revised: 10/28/2008
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The Customer Service Representatives can correct the beneficiary's name in FISS to match CWF. Please call 1-877-235-8048 for assistance.
(Question based on July 2008 top phone inquiries)
Date Posted: 09/11/2008, Date Reviewed/Revised: 10/28/2008
How do I bill a no-payment claim to receive a rejection for other insurance?
A No-payment claim needs to contain the following information:
TOB - XX0
Covd Days - 0 (if applicable)
Non-covered charges
Condition Code 21
Remarks indicating why you are billing a no-payment claim.(Question based on July 2008 top phone inquiries)
Date Posted: 09/11/2008, Date Reviewed/Revised: 10/28/2008
How can I determine if I billed the correct patient status code on my claim?
Prior to billing a claim, providers should verify where they discharged the patient by checking their medical records. If a provider's claim is sent to the RTP file or rejected indicating an incorrect patient status code was billed, providers should check with their medical records department to verify what the correct patient status code is. The Quick Reference Guide for Filing a Medicare Part A Claim has a list of patient status codes. If you need additional assistance, please call the customer contact center at f1-877-235-8048.
(Question based on August & September 2008 top phone inquiries)
Date Posted: 09/11/2008, Date Reviewed/Revised: 10/28/2008