Wch April Bulletin 2012

WCH BULLETIN

April 2012

VOLUME 3

ISSUE 4

WCH Service Bureau is a proud member of the following professional organizations:

ICD-10 Compliance!on page 3

ICD-10 has moved to 2014 year!on page 8

We have new CFPC on staff….find out who on page 4

ICD-10 has moved to 2014 year!on page 8

Welcome to our April Edition!

We have new CFPC on staff….find out who on page 4

Welcome to our April Edition!

WCH Service Bureau is a proud member of the following professional organizations:

ICD-10 Compliance!on page 3

INSIDE THIS ISSUE:WCH BUZZ

Please Welcome our new staff!...........

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NEWS BY SPECIALTY...................................... ...13

STATES UPDATES.........................................................................................................................14

QUESTIONS AND ANSWERS .................................................................................................15

FEEDBACK......................................................................................................................................16

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New CFPC coder in WCH!..................

Duties that can be delegated to physician assistant (PA)..........................................

Medicaid requirements for providers Payments.

Compensation Basics............................................................................

ICD-10 Code Conversion on WCH website.

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New ICD-10 deadline will be Oct. 1, 2014...........................

Medicare Redesigns Medicare Summary Notice MSN.....................................................................

On Mon Apr 23, CMS will release a national provider Comparative Billing Report (CBR) addressing

Cardiology Services ............

Prior Authorization Required for Rehabilitation Visits - Effective February 23, 2012............

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Understanding Prepayment Audit Reviews..............................................................................7

June 30th Deadline to Prevent ePrescribing Penalty for 2013.

HEALTHCARE UPDATES

Liz shared with us some of her impressions and plans for the future.

Q: Please tell us, what did you feel when you passed exam and received CFPC certificate from

A: I was very thrilled! I spent a lot of time for the exam preparation and I had finally passed it successfully.

Q: Are you planning to take another AAPC administrated tests any time soon?

A: Yes I'm planning to take at least 2 exams in the nearest future CPMA – Certified professional Medical Auditor, which will give the knowledge of the medical records auditing, quality assurance,

When I received the news that I had passed my exam, I was excited beyond control. I had immediately called my husband and told him about my results. He was very proud of me. I know more confident than ever before in my knowledge's and abilities to help my clients. I am grateful to WCH for the experience and knowledge's I have obtained while working in the billing department. I am looking forward to a great career in WCH.

Please Welcome our new staff! We would like to announce the addition of eleven new staff members in our billing department team! Let us introduce them (from left side):Lika Gimattudinova, Albert Khamidulin, Mila Ibragimova, Adele Salikhova, Vasiliy Firsov, Niyaz Iskhakov, Bulat Sagirov, Adelina Mukhametzyanova, Julia Saraeva, Fanis Shigapov and Karina Lebedeva. We are very lucky to have this new addition. You will have pleasure working with the new staff!

New CFPC coder in WCH! WCH Service Bureau, Inc is proud to announce that we

have new CFPC coder. WCH would like to congratulate Liz Bannova Billing Department Supervisor for her

professional achievements! She has recently successfully passed the CFPC exam. She showed great determination,

knowledge and we are all very proud of her! Congratulations, Liz!!!

Liz BannovaBilling Department Supervisor, CMRS, CFPC

WCH BULLETIN VOLUME 3 ISSUE 2

3047 Avenue U, Brooklyn NY 11229 Phone: 888-WCHEXPERTS Fax: (718) 504-6072 www.wchsb.com

http://aapc.com

fraud and abuse. And CCC - Certified Cardiology Coder.

Q: Your Certification is in family practice, what areas are you going to cover specifically?

Ÿ Coding of ancillary procedures performed in family practice medicineŸ Coding of minor surgical procedures performed in family practice medicineŸ Time based codingŸ Evaluation and Management

Q: How do you feel, your CFPC certificate and experience in this area will help clients in WCH?

A: By having this certification, I know that I can help and protect WCH clients. I know how to work with the demands from the insurance companies, now I better understand insurance policies and their requirements from doctors. I will help my clients fight their audit requests and better organize their chart keeping.

Q: What do you recommend for your colleagues who are planning to take the exam, how should they prepare?

A: I would recommend to anyone who's planning to take this exam to prepare very thoroughly. The key elements for taking this exam is time management and organization of the material. The exam is about 6 hours long that is why time management is very important task for this exam.

Q: What are your plans and ambitions for the future, and how will you achieve them?

A: I am married and raising a daughter who sometimes can take away time from my professional growth. I am definitely planning to add more certificates from APPC to my list. I am looking forward to working in WCH and developing educated staff and expanding the clientele network.

WCH is very proud of Mrs. Bannova's new credentials!! Way to go!



Duties that can be delegated to physician assistant (PA)

In NY State the following duties can be delegated by supervising physician to physician assistant:

1. Evaluation - initially approaching a patient of any age group in any setting to elicit a detailed and accurate history, perform an appropriate physical examination, delineate problems and record and present the data;

2. Monitoring - assisting the physician in conducting rounds in acute and long term inpatient settings, providing care in office-based and other ambulatory care settings, developing and implementing patient management plans, and recording progress notes;

3. Diagnostics - performing and/or interpreting, at least to the point of recognizing deviations from the norm, common laboratory, radiologic, cardiographic, and other routine diagnostic procedures used to identify pathophysiologic processes;

4. Therapeutics - performing routine procedures such as injections, immunizations, suturing and wound care, managing simple conditions produced by infections or by trauma, assisting in the management of more complex illnesses and injuries, and taking initiative in performing the evaluation and therapeutic procedures in response to life threatening situations. Physician assistants are authorized to "supervise and direct" the withdrawal of blood to determine alcoholic or drug content for use in detecting violations of the Vehicle and Traffic Law;

5. Counseling - instructing and counseling patients regarding compliance with prescribed therapeutic regimens, normal growth and development, family planning, emotional problems of daily living, and health maintenance; and

6. Referral - facilitating the referral of patients to other health related practitioners and community health and social service agencies when appropriate. Slava Kurdov Assistant Manager,CPC

One of our clients from New York State has asked to provide duties of PA based in the Medicare requirements. We wanted to share this information with every client, maybe it will interesting for your practice.



NY State Medicaid will soon require all billing providers to register for EFT and ERA or PDF remittances beginning in September 2012. This effort moves NY State Medicaid in the direction of health care industry standards of practice. Also costs savings associated with reducing the production, processing and mailing of paper. In spite of that this process will begin in September 2012 all providers are strongly recommended to begin registering their EFT now in order to reduce burden, time waste and claims hold.

The advantages of EFT over paper checks are:

Ÿ Eliminate the possibility of lost checks.Ÿ Eliminate delays that would be caused by misdirected checks.Ÿ Eliminate mail time.Ÿ Enjoy knowing your funds are secure.Ÿ Save trips to the bank to deposit your Medicaid checks.

ERA/PDF in addition to requiring EFT, providers will also be required to enroll for paperless remittances. There are two options: Ÿ Option 1: ERAs in the form of HIPAA compliant 835/820 formats. These will require software to interpret but have advantages for systematic posting of payments. Ÿ Option 2: PDF version of the paper remittance delivered electronically through eMedNY's secure

web site. PDF remittances have many advantages over paper remittances such as: Ÿ The PDF remittance will be immediately available every week on the Monday on which you're

Medicaid check is dated, and will not be subject to the two-week hold of your check or EFT release. Ÿ You will know when the PDF is available in your exchange account and not have to wait for the mail. Ÿ The remittance can be downloaded and stored electronically for easy retrieval. Ÿ The remittance can be word-searched to help locate specific claims. Ÿ The PDF will look exactly like the paper remittance. Ÿ Remittances can be printed with Adobe Reader® (6.0 release or higher required), available free of

charge. Hurry up to enroll EFT ERA/PDF now and you will reduce registering period and it will be faster than you decided to apply for it in September 2012.

Qualified Credentialing specialists of WCH SB can help all kind of providers in all states to enroll EFT and ERA/PDF. For more detailed information please contact our credentialing department at 718-934-6714 x 1102. Dora Mirkhasilova

Credentialing Specialist

[email protected]

Medicaid requirements for providers Payments.

IMPORTANT NEWS FROM CREDENTIALING DEPARTMENT





Understanding Prepayment Audit Reviews.By: Mathew J. Levy, Esq.

Stacey Lipitz Marder, Esq.Kern Augustine Conroy & Schoppmann, P.C.

Overview: The unfortunate reality is that the cost of running a medical practice is increasing while reimbursement from third party payers is decreasing. In order to survive, it is crucial that physicians get paid for the services rendered to their patients in a timely manner. In today's climate, insurance companies are engaging in several tactics in order to make it more difficult for physicians to receive proper reimbursement.

1In addition to overpayment demands , insurance carriers are delaying and making it more difficult for physicians to get paid through prepayment audits. Being placed on prepayment audit review is extremely frustrating for a physician, and can ultimately have a devastating impact on the operation of a practice. We have outlined a few key concepts that every physician should understand in order to avoid and be removed from a prepayment audit if applicable.

What is prepayment audit review?When a physician has been placed on prepayment audit review, each time the

physician submits a claim, the claim is denied by the insurance carrier and there is a request that the physician submit a copy of his/her medical

2records in order to support the claim . insurance carrier receives the medical records, the records are reviewed in order to determine whether the claim should ultimately be paid or not. Even if the claim is eventually paid, payment would not be made until approximately 90-120 days after the claim is submitted, as opposed to 30 or 45 days in the event the physician was not on prepayment review. This process can be very costly for a physician - in addition to the physician's staff spending countless hours preparing the medical records to be submitted to the insurance carrier, the delay in payment can have a significant impact on cash flow as many physicians rely on reimbursement from insurance carriers in order to pay their employees and run their practices.

How does this happen:Insurance carriers, including Medicare, are investing heavily in billing software programs.

Once the

This firm has handled a number of Medicare, OMIG and private payer audits. A knowledgeable legal counsel can be indispensable, particularly when the amounts that the payers are trying to recover are significant. WCH highly recommends the services of this firm. Exclusively for our clients, the firm has prepared an interesting and useful article on Prepayment audit review.

These sophisticated billing software programs are able to compare a physician's billing habits with those of his/her peers in his/her specialty and geographic location. To the extent that a physician's billing pattern differs from the insurance carrier's predetermined norms, the insurance carrier may place the physician on prepayment audit review so that the carrier can justify payment based upon a review of the medical records.

will contact and negotiate with the insurance carrier. In order to be removed form prepayment audit review, the physician must be in compliance with the insurance carrier's requirements regarding coding and documentation. If a physician is placed on prepayment audit rereview, it is recommended that the physician begin the removal process immediately in order to avoid being placed on prepayment audit review by other carriers. Since the insurance carriers often enter into arrangements with third party contractors (who have relationships with the other carriers) to review records, if a physician is on one carrier's radar, there is a good chance that the physician will be hit with multiple audits from other carriers.

How to avoid being placed on prepayment review:

How to be removed from prepayment audit review:In order to ensure removal from prepayment audit review, it is imperative that the physician have his/her medical records reviewed and analyzed so that it can be determined whether the physician's documentation supports the code submitted. In the event that a physician's documentation does not justify the codes submitted, the physician must rectify such billing deficiencies going forward. Once the records have been reviewed, the physician's healthcare team, including attorneys and coding experts,



Physicians must recognize that today's billing and coding systems dictate the need for specialized assistance. As such, physicians must ensure that their current billing practices are in compliance with the carrier's policies, and that their documentation adequately supports their billing claims. From simple pre-printed forms, through digital transcription to an electronic medical record, ample resources exist that can document the level of services rendered, confirm the medical necessity for those services and bar prepayment audit reviews. Furthermore, an annual review conducted by a certified coder can provide valuable insight into what areas are currently under scrutiny, what trends are developing with one's peers and/or what can be done to keep the practice in the mainstream. Advice from any billing resource should be provided verbally (any written reports could be discoverable in any future proceedings) and should be provided directly to the physicians involved. Physicians who are willing to recognize that billing and coding in today's medical practice management environment is very complex, and who obtain ongoing advice from specialists, will have taken an enormous first step in avoiding coming under review and the potentially devastating impact of a prepayment audit review.

Conclusion:Being placed on prepayment audit review can be very frustrating for a physician since payments are delayed and there are additional administrative burdens placed on the physician's staff. To that end, in the event that a physician is placed on prepayment audit review, it is in the best interest of the physician to retain a team of professionals specializing in health care – attorneys and coding experts– to ensure that the claims submitted to the insurance carriers are

substantiated by the documentation in the medical records and that the physician's billing is in compliance with the insurance carrier's guidelines. Although it can be a trying process which may take several months to resolve, resolution does not have to be expensive for physicians. Physicians must recognize that there is hope and that there is light at the end of the tunnel with respect to prepayment audit reviews.

About the Authors:Mathew J. Levy, Esq. is a Principal of Kern Augustine Conroy & Schoppmann, PC. Mr. Levy is nationally recognized as having extensive experience re-presenting healthcare clients in transactional and regulatory matters. Mr. Levy has particular expertise in advising health care clients with respect to contract issues, business transactions, practice formation, regulatory compliance, mergers & acquisitions, professional discipline, criminal law, healthcare fraud & billing fraud, insurance carrier audits, litigation & arbitration, and asset protection-estate planning. You can reach Mathew Levy at 516-294-5432 or . [email protected]



Stacey Lipitz Marder is an associate at Kern Augustine Conroy & Schoppmann, PC with e x p e r i e n c e r e p r e s e n t i n g h e a l t h c a r e p r o v i d e r s i n connection with transactional and regulatory matters including the formation and structure of business entities, negotiating and drafting contracts and commercial real estate leases, stock and asset acquisitions and general corporate counseling. Ms. Marder also has experience advising healthcare clients on a wide range of regulatory issues including Stark, the Anti-Kickback Statute, fraud and abuse regulations, HIPAA, reimburse-ment and licensing matters.You can reach Stacey Lipitz Marder at +1 800-445-0954 or [email protected]

Remark codes 1- Overpayment demands involve insurance carriers conducting an audit and review of a physician's medical records in order to determine whether the amount that was previously paid to the physician was substantiated by the records. Often times the insurance carriers determine that the records do not substantiate the services billed, and the insurance carriers then demand that the physician refund the amount of paid that is in excess of the appropriate payment as determined by the carrier. The refund demand does not only take into account the amount involved in the audit, rather the carriers extrapolate the amount to extend over a randomly selected number of past years.

2- An insurance carrier may place a physician on prepayment audit review in connection with all claims submitted by the physician, or on in connection with claims involving specific services.

mailto:[email protected]



Compensation Basics.

In this article, we would like to clarify for our clients two major federal laws (Anti-Kickback Statute – Criminal, intent based, Stark Law – Civil, strict liability) and explain their difference.

Anti-Kickback Statute – Criminal, intent based. Ÿ It is a criminal offense to knowingly and willfully offer, pay, solicit, or receive anything of value, directly or indirectly, overtly or covertly, in cash or in kind, to purposefully induce or reward referrals of items or services payable by a Federal health care program. Ÿ Physician referrals to their employer are covered by this statute. Ÿ Safe harbors are available to protect certain arrangements. Ÿ Stark Law – Civil, strict liability. Ÿ If a physician has a financial relationship with a health care entity, the physician may not make referrals to that entity for the furnishing of designated health services (DHS) under the Medicare program. Ÿ To avoid a Stark violation, you MUST meet an exception if there will be DHS referrals by the employee to the employer

Anti-Kickback Employee Safe Harbor – bona fide employees only (common law definition). Protects all referrals between employed physician and employer.

Stark Law Employee Exception Ÿ Bona fide employee (common law definition) Ÿ Identifiable services Ÿ Salary + bonus is fair market value for the employee's services and is not tied to volume or value of referrals Ÿ Commercially reasonable even without referrals from employee to employer Ÿ Productivity bonuses are ok, IF only reflect services personally performed by the physician (may not include “incident to” services) Ÿ Can require employee to refer to employer.

WCH have placed on website new ICD-10 Code Conversion just might make your job a little easier. The ICD-10 code translator tool allows you to compare ICD-9 to ICD-10 codes. ICD-9 is being expanded from 17,000 to approximately 141,000 ICD-10 codes, and this online tool can help you map that expansion. (Note: this tool only converts ICD-10-CM codes, not ICD-10-PCS.)This tool is based on the General Equivalency Mapping (GEM) files published by CMS, and is not intended to be used as an ICD10 conversion, ICD-10 mapping, or or ICD-9 to ICD-10 crosswalk tool. Keep in mind that while many codes in ICD-9-CM map directly to codes in ICD-10, in some cases, a clinical analysis may be required to determine which code or codes should be selected for your mapping. Always review mapping results before applying them.

ICD-10 Code Conversion on WCH website.

HEALTHCARE UPDATES

June 30th Deadline to Prevent ePrescribing Penalty for 2013.Physicians have until June 30, 2012 to report on at least 10 electronic prescriptions, known as e-scripts, or file a hardship exemption to avoid a 1.5 percent reduction in Medicare Part B payments in 2013. The AMA has provided an excellent "tip sheet" to help providers avoid this significant penalty. View the AMA tips to learn more at.http://www.ama-assn.org/resources/doc/hit/avoid-erx-penaltytip.pdf

New ICD-10 deadline will be Oct. 1, 2014. The time line for healthcare organizations to convert to the ICD-10 coding system will likely be delayed one year to Oct. 1, 2014 U.S.. The delay is part of a proposed rule, that would create a unique health plan identifier that HHS estimates could save doctors and insurers $4.6 billion over the next decade.

Medicare Redesigns Summary Notice MSN.

The Centers for Medicare & Medicaid Services (CMS) announced March 7 that it has redesigned its Medicare Summary Notice (MSN). This statement informs Medicare beneficiaries about their claims for Medicare services and benefits. The new MSN is now available online at and will be mailed quarterly to beneficiaries starting in 2013.

MyMedicare.gov

On Mon Apr 23, CMS released a national provider Comparative Billing Report (CBR) addressing Cardiology Services.

The CBRs are produced by Safeguard Services under contract with CMS and will provide comparative data to help show how these individual providers compare to other providers within the same field. These comparative studies are designed to help providers review their coding and billing practices and utilization patterns, and take proactive compliance measures. Providers should view CBRs as a tool, rather than a warning, as a way to aid them in properly complying with Medicare billing rules. It is also important to understand that CBRs do not contain patient or case-specific data, but rather only summary billing information as a method of ensuring privacy.



Prior Authorization Required for Rehabilitation Visits - Effective February 23, 2012.

In October 2011, a limit of 20-visits per 12-month period for Medicaid fee-for-service (Medicaid FFS) enrollees was implemented in New York State. This 12-month period is based on the state's fiscal year of April 1 – March 31. For Medicaid managed care (MMC) and Family Health Plus (FHPlus) enrollees, the 20-visit limit is based on a calendar year (January 1 – December 31. )

This 20-visit benefit limit applies to rehabilitation visits in private practitioners' office, certified hospital out-patient depart-ments, and diagnostic and treatment centers. If more than 20 visits in a benefit year are required, the enrollee may elect to pay privately. Providers should discuss payment arrangements with enrollees and should also ask them to sign a written agreement with the specifics of the payment arrangement clearly outlined. This discussion should take place prior to the 21st visit.We were recently informed that effective February 23, 2012, prior authorizations (PA) will be required for physical therapy services that are provided to fee-for-service Medicaid enrollees.

All providers that submit claims or prior authorizations for Medicaid FFS enrollees must now use a modifier which will identify the therapy type. For physical therapy, the modifier is GP. Any claims submitted without the modifier will be denied. Medicaid FFS providers do not need to obtain a prior authorization for FFS enrollees who are exempt from the 20-visit limit or for rehabilitation therapy provided in exempt settings.

Additional information can be found on the NYPTA website (www.nypta.org) under the Payment section.

Depression Screening covered by Medicare G0444 Effective for claims with dates of service on and after April 2, 2012, contractors shall pay for annual depression screening claims, G0444, only when services are provided at the following Places of Service (POS):Ÿ 11 - Office Ÿ 22 - Outpatient hospitalŸ 49 - Independent clinic Ÿ 71 - State or local public health clinic

Note: Coverage is limited to screening services and does not include treatment options for depression or any diseases, complications, or chronic conditions resulting from depression, nor does it address therapeutic interventions such as pharmacotherapy,combinat ion therapy (counsel ing and medications), or other interventions for depression. Self-help materials, telephone calls, and web-based counseling are not separately reimbursable by Medicare and are not part of this NCD. Screening for depression is non-covered when performed more than one time in a 12-month period. Eleven full months must elapse following the month in which the last annual depression screening took place. Medicare coinsurance and Part B deductible are waived for this preventive service.



Radiology Q: and 75894 be used twice for intervention done on both the left internal maxillary artery branches and then on the right side, or is the entire "head" considered one field? The

question applies then to 75898 for follow-up angiography when intervention is done on both sides. We billed only one each for 61626, 75894, and 75898, even though embolization was done of the left and right internal maxillary artery branches.

A: Code 61626 should be assigned only once to identify the two vessels feeding one operative field.

RespiratoryQ: When a patient is present for a stress test and the question arises regarding proper use of the patient's inhaler, can we bill for the physician's instruction to the patient about the inhaler?

A: No if the physician only provided a brief instruction. There is no code for that service specifically. Evaluation and management (E&M) codes are based on time, which requires documentation of the total time and how much of that time was spent in counseling and level of detail for the counseling involved

When doing a transcatheter embolization of the head and neck for epistaxis, can 61626

SPECIALTY Q&A

Cardiology Q: Can we code 93503 with a combined left and right heart catheterization?

A: No, according to the American College of Cardiology (ACC) and American Medical Association (AMA), 93503 cannot be reported with codes for diagnostic cardiac catheterization because recordings of intracardiac and intravascular pressures, blood sampling for measurement of oxygen saturation or blood gases, or cardiac output measurements are considered an integral component of those procedures.

Laboratory Q: Is it correct to report CPT code 88161 for a cytopathology prep from a fluid?A: To report a cytopathology preparation from a fluid, washing, or brushing, assign a code from the CPT range of 88104–88112. Do not additionally report a code from the 88160–88162 range because these reference “any other source,” which excludes fluids,

washings, or brushings.



STATES UPDATES

Connecticut "Connecticut is the first state to receive federal approval to expand Medicaid under the Affordable Care Act (national health care reform legislation). This new Medicaid coverage is replacing the State-Administered General Assistance (SAGA) medical program. Medicaid for Low-Income Adults (MLIA) is open to Connecticut residents aged

19 through 64, who do not receive federal Supplemental Security Income or Medicare and who are not pregnant.”

Medicare Health and Drug Plans in Connecticut:Ÿ 48 Medicare Prescription Drug Plans (PDPs) availableŸ 86% of people with Medicare have prescription drug coverage (including 55% with Part D)Ÿ 35% of people with Part D get Extra Help (also called the low-income subsidy, or LIS)Ÿ 100% of people with Medicare have access to a MA plan for a $0 premium

FloridaFlorida Medicaid Reform Pilot Good for Patients and Taxpayers. The Florida reforms work by giving patients a choice of the private health plan that works best for them. Enrollees can choose from plans with varied benefits and provider networks, and a monetary rewards system creates incentives for healthy, responsible

behavior. By shifting away from failed policies of central planning toward a consumer-driven program, the program has been successful on a number of levels.The waiver extension of Florida's patient-centered Medicaid reform preserves the expanded choices, incentives for healthy behavior, and increased health services that pilot patients have enjoyed for years. Pilot patients have better health outcomes and report higher satisfaction rates with their plans, their care, and their access to specialists than their counterparts who are confined to traditional Medicaid and commercial HMOs.The bottom line with Florida's Medicaid Reform is that when the patient is the priority, government and HMO bureaucrats are finally held accountable. Costs flatten and patient health and satisfaction improves.The decision by CMS reaffirms that Florida's Medicaid reform pilot is a national model for other states to achieve a healthier, happier Medicaid population at a lower cost to taxpayers. CMS should now move quickly to approve a planned statewide expansion of the reform so all Florida Medicaid patients can enjoy the program's success.



QUESTIONS AND ANSWERS1. Q: I electronically prescribe while providing services not included in the denominator of the Electronic Prescribing (eRx) Incentive Program measure, such as outpatient procedures. How can I be sure the eRx quality-data code (G8553) is being counted to avoid future eRx payment adjustments?

A: While reporting during the 2012 eRx 6-month reporting period to avoid the 2013 eRx payment adjustment, eligible professionals can submit the eRx quality-data code (G8553) on any payable Medicare PFS claim during the 6-month reporting period (1/1/2012-6/30/2012). When reporting eRx quality-data codes, be sure they are submitted on a claim with other payable services. If the claim contains services that are in the denominator of the eRx measure, those eRx events will also count toward your 2012 eRx incentive reporting requirement (25 events). Note: For the incentive, ALL 25 encounters MUST be associated with a denominator code.

2. Q: Will I receive anything showing that Medicare received my claims with G8553?

A: Yes. The eRx line items will be denied for payment, but are passed through the claims processing system to the National Claims History database (NCH), used for eRx claims analysis. Eligible professionals will receive a Remittance Advice (RA) which includes a standard remark code (N365). N365 reads: “This procedure code is not payable. It is for reporting/information purposes only.” The N365 remark code does NOT indicate whether the eRx G-code is accurate for that claim or for the measure the eligible professional is attempting to report. N365 only indicates that the eRx G-code passed into NCH.



FEEDBACKWe want to know what topics you will enjoy reading in our issues. Please bring up the topics for discussion. All topics can be emailed to Olesya Petrenko Marketing Manage

skype: wchsb.olesya

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[email protected] [email protected]

Have a great

Spring!!!!



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Wch April Bulletin 2012

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Transcript of Wch April Bulletin 2012