Medicare / Medi-Cal News
Don't forget to check Medicare patients' eligibility! Traditional Medicare doesn't require much pre-authorization, but Medicare HMO's often do. Medicare could deny your claim if your patient switches to an HMO, then the HMO could deny your claim because you didn't have prior authorization.
When documentation is required to process a Reopening, providers must submit the request as a Written Reopening with a completed "Reopening Form" or through Endeavor. If a request is more complex, beyond clerical errors or omissions, it is appropriate to submit a Redetermination via the "Redetermination Form."
For more Telephone Reopening information, go to https://med.noridianmedicare.com/web/jeb/topics/appeals/telephone-reopening.
Avoiding Denials on Priced Per Invoice Claims
Processing Changes: Effective 9/16/13, items requiring an invoice must follow certain criteria.
Single Chamber and Dual Chamber Permanent Cardiac Pacemakers – Coding and Billing
The National Coverage Determination (NCD) 20.8.3, Single Chamber and Dual Chamber Permanent Cardiac Pacemakers were revised with an effective date of August 13, 2013. The CMS A/B Medicare Administrative Contractors (MACs) have been instructed to implement the NCD at the local level. The following provides coding and billing instructions for the implementation of NCD 20.8.3. (CMS policy language is in italics.) The NCD "Item/Service Description" and "Indications and Limitations" are repeated here.