- Home
- » e-Newsletters
ASCs in the news: CMS discusses ASC requirements for physician names and NPIs on claims for diagnostic services
Ambulatory Surgery Reimbursement Update, September 23, 2008
CMS has issued MLN Matters 6129, based on Transmittal R5172CP. The article clarifies changes affecting ASCs who submit claims to Medicare Administrative Contractors (MAC) or carriers for services provided to Medicare beneficiaries.
Beginning January 1, 2009, ASCs must report the ordering/referring physician on claims for diagnostic radiology services, the same as for other Part B claims for diagnostic services, technical component (modifier -TC). The ordering/referring physician’s name needs to appear in block 17 and the physician National Provider Identifier (NPI) needs to appear block 17B of the CMS-1500 on paper claims, and be similarly present on electronic claims.
CMS will return claims without the ordering/referring physician’s name or NPI with claim adjustment reason code 16 (Claim/service lacks information necessary for adjudication) and one of the following remittance advice remark codes:
- N264—Missing/incomplete/invalid ordering provider name
- N265—Missing/incomplete/invalid ordering provider primary identifier
- N285—Missing/incomplete/invalid referring provider name
- N286—Missing/incomplete/invalid referring provider primary identifier
If the billing provider cannot obtain the ordering/referring provider’s NPI, and cannot find it on the NPI Registry, enter the billing provider in X12N 837 transactions or the service provider in NCPDP 5.1 transactions in the ordering/referring field as a temporary solution. This entry is subject to postpayment review.
To read the complete article, click here.
Most Popular
- Articles
-
- Q/A: Billing telemetry daily monitoring
- Credentialing monthly: What is the role of the credentials committee in addressing unprofessional conduct?
- 2010 ICD-9 code updates now available online
- Master modifiers to ensure accurate reimbursement
- H1N1 hits Maine facility
- Radiologist indicted for fraudulently signing reports
- Don’t be scared into silence: Affiliation letter safeguards allow you to disclose more
- National Quality Forum creates standardized set of data for electronic health records
- New report reveals $47 billion in Medicare fraud
- Understand the H1N1 Flu and how to code it
- E-mailed
-
- Credentialing monthly: What is the role of the credentials committee in addressing unprofessional conduct?
- Q/A: Billing telemetry daily monitoring
- Radiologist indicted for fraudulently signing reports
- H1N1 hits Maine facility
- New report reveals $47 billion in Medicare fraud
- Revised MS.1.20 'huge improvement', out for comment again
- Briefings on Outpatient Rehab Reimbursement and Regulations, December 2009
- Hand hygiene rates improved through variety of reinforcement styles
- Press Ganey report: Patient satisfaction increasing across the country
- Residency Program Alert, December 2009
- Searched