December 2007 Medicare Bulletin - Tennessee Insert
Posted December 4, 2007
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Table of Contents
- Denials for Multiple Inpatient Hospital Evaluation and Management Services
- The Quarterly Ask-the-Contractor Teleconference
TopDenials for Multiple Inpatient Hospital Evaluation and Management Services
CIGNA Government Services customer service has recently been experiencing increasing calls concerning denials for Inpatient Hospital E&M services, performed on the same date of service as a Consultation by providers who are in the same group, but have different specialties using the same diagnosis code.
The following information is a reminder of the guidelines to apply when billing multiple Inpatient Hospital E&M services, including Consultations on the same date of service.
Example 1 Inpatient Hospital Visit and Consultation Same group
- Must have different specialties
- May have same diagnosis code
Example 2 Two or more Inpatient Hospital Visits Same Group
- Must have different specialties
- Must have different diagnosis code
As stated in CMS Publication 100-4, chapter 12, section 30.6.9.c, CGS recognizes that there are limited occasions "where concurrent care may be billed by physicians of the same specialty." We are making efforts to provide a work around for these occasions. Those claims will be considered for (not guaranteed) for payment if all the following apply.
Example 3 Two or more Inpatient Hospital Visits Same Group – Same Specialty
- Must have different diagnosis code
- Must be different provider
- Cannot be Critical Care Services
References: CMS Publication 100-04, chapter 12, sections 30.6.5, 30.6.9.c
The Quarterly Ask-the-Contractor Teleconference
***Attention Tennessee Providers***
The quarterly Ask-the-Contractor Teleconference will be held on Wednesday, December 12th from 10am-11am Central Time (11am-12pm Eastern Time). No pre-registration is required for this call. There are a limited number of lines available, and participation is on a "first come, first served" basis. The toll-free call in number is 1.877.852.6580.
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