North Carolina Customer Service Frequently Asked Questions
First Quarter 2007
| Q1. | My care plan oversight charges are being denied as unprocessable. If all the information is being provided on the claims, why are these services still denying? |
| A1. | On October 2, 2006 , the CMS implemented updated instructions to the Medicare carriers and provider community regarding Care Plan Oversight (CPO) services. These updated guidelines would affect services on and after January 1, 2005 . MLN Matter article MM4374, was published to clarify the policy associated Care Plan Oversight. One of the key points this article mentions is that Carriers will not require the provider number of the Home Health Agency or Hospice for CPO claims effective for services on and after January 1, 2005. Any claims processed after the date of implementation above and have the HHA or Hospice provider number will deny as unprocessable. (http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM4374.pdf) |
| Q2. | The code(s) we billed are denying with Remark Code B15. Where can I find a listing of codes that are not paid separately? |
| A2. | Denials with Remarks Code M80 (CO-B15) are due to the Correct Coding Initiative guidelines. The Center for Medicare & Medicaid Services (CMS) developed the Correct Coding Initiative (CCI) to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims. The CMS also developed its coding policies based on coding conventions defined in the American Medical Association's CPT manual, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices. To access and view the complete National CCI table for physician codes, please refer to the CMS web site at: http://www.cms.hhs.gov/NationalCorrectCodInitEd/01_overview.asp#TopOfPage. |
| Q3. | Have there been any changes to the screening colonoscopy codes for 2007? |
| A3. | Effective January 1, 2007, Medicare will waive the annual Part B deductible for colorectal cancer screening tests billed with the codes listed below:
While the deductible will be waived, and will not apply for codes listed above, furnished on or after January 1, 2007 , the Medicare Part B coinsurance will apply for these screening tests. (MLN Matter article MM5127; http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5127.pdf) |
| Q4. | I have looked at the new fee schedule for the upcoming year and cannot find particular codes (i.e. mammograms). Where can I find the Medicare allowable for these codes? |
| A4. | Some codes that we've become familiar with may be updated by the appropriate association, academy, or society who maintains these codes. This may result in the code being deleted for the upcoming year and replaced with a new code(s). When looking for the Medicare allowable for codes not listed on the physician, drug, or clinical laboratory fee schedules, please be sure to check the CPT or HCPCS code books, for any updates to the code(s) in question. |
| Q5. | Do I have to file the MSP claims electronically as I do my regular Medicare claims, or can MSP claims be "paper" filed? |
| A5. | If you are required to submit Medicare claims electronically, there is no exception for Medicare secondary claims, unless there is more than one primary payer to Medicare. Providers who are capable of filing MSP claims electronically to Medicare should review the required steps to ensure the primary payer data is submitted correctly to avoid delays in claims processing and payment consideration. If you have any questions regarding submitting MSP claims electronically, please contact your clearinghouse/vendor or you may contact the NC EDI Department at 1.866.352.1608. |
| Q6. | We were not aware that our patient had other insurance primary to Medicare. Who is responsible for obtaining this information? |
| A6. | CMS instructs providers to aid in the collection and coordination of beneficiary insurance information by requesting updated insurance profiles from the patient at each visit. CMS suggests incorporating an MSP questionnaire into all patient health records. After the initial MSP information is obtained, providers are asked to collect the beneficiary's updated insurance information at each patient visit. The following questions may be used when obtaining the initial and/or updated MSP information:
For more information, please refer to the CMS Medicare Learning Network (MLN) product currently posted on their web site at http://www.cms.hhs.gov/MLNProducts/downloads/MSP_3a.pdf. |
| Q7. | When using the IVR system, which button do I hit for the letter "Z"? |
| A7. | If your telephone does not have the letter "Z" listed on the keypad, please hit number "9". The number "9" is used for letters "W", "X", "Y", and "Z". |
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