Q&A: You've got questions! We've got answers!
Physician Practice Insider, June 12, 2017
Q: Can a claim that is edited for a noncovered procedure be appealed?
A: If a claim is edited for a noncovered procedure, the claim cannot be submitted to CMS for appeal. Therefore, once the coding of the noncovered procedure is validated, the process to split the noncovered procedure onto a sepa¬rate claim must be followed so that at least one claim can be submitted and processed. Then an appeal can be filed if the provider actually believes the procedure should be or is covered. With version 33 of the Medicare Code Editor (MCE), the first version of the MCE using the ICD-10 codes, CMS acknowl¬edged errors in this list of noncovered procedures and provided instructions to Medicare Administrative Contractors to process claims having the errors as described in the IPPS
For more information, see The Chargemaster Essentials Toolkit.
Editor’s note: Email your questions to Editor Karen Long Rayburn at klong@decisionhealth.com.
Related Products
-
Physician Practice Perspective
Physician Practice Perspective subscribers can find the archive of issues on the Part B News website. Find more information...
-
Medical Environment Update
A subscription to Medical Environment Update pays for itself by saving you time sorting through complex regulations and...
-
HealthLeaders Media Physician Leaders
HealthLeaders Media Physician Leaders offers commentaries that focus on the hottest issues for doctors as well as concise...
-
Medical Environment Update - Electronic and Print, 1 year
A subscription to Medical Environment Update pays for itself by saving you time sorting through complex regulations and...
-
Medical Environment Update - Electronic, 1 year
A subscription to Medical Environment Update pays for itself by saving you time sorting through complex regulations and...
Most Popular
- Articles
-
- Note similarities and differences between HCPCS, CPT® codes
- Differentiate between types of wound debridement
- Maryland health system locked out of network by ransomware
- Don’t forget the three checks in medication administration
- Practice the six rights of medication administration
- Know guidelines and subtle differences in code descriptions for laceration repairs
- OB services: Coding inside and outside of the package
- What is the difference between an IPA and a medical group?
- What to include on the incident report
- Reimbursement for Facility and Professional Services in a Provider-Based Department by Gina M. Reese, Esq., RN
- E-mailed
-
- Safety Month showcase: Tips for assessing behavioral health units for ligature risks
- Q&A: What, no gloves needed in blood donation centers?
- Q&A: Sepsis as a primary diagnosis
- Q&A: Emergency room documentation and radiology reports
- Note from the Instructor: Provider-Based vs. Freestanding Locations: Financials Flip-flop with New Packaging
- Is it a HIPAA violation for physicians to take patient charts home?
- Immediate Jeopardy - Why this finding can be disastrous to your facility.
- HIPAA Q&A: Transporting records to satellite clinic
- Differentiate between types of wound debridement
- Correct use of modifier -AY for ESRD
- Searched