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
Most Popular
- Articles
-
- Don't forget the three checks in medication administration
- FDA says to decrease reuse of devices, CMS removes some blanket waivers
- Note similarities and differences between HCPCS, CPT® codes
- Practice the six rights of medication administration
- Nursing responsibilities for managing pain
- Skills of effective case managers
- Clearing up the confusion: CPT codes 76376 and 76377
- The consequences of an incomplete medical record
- Steps for maintaining patient privacy
- Q&A: Primary, principal, and secondary diagnoses
- E-mailed
-
- FDA says to decrease reuse of devices, CMS removes some blanket waivers
- Peer review using a retired physicain without liability insurance
- Q/A: Coding for wound care with no-cost skin substitute
- Q&A: Atelectasis query for secondary diagnosis
- Proper coding for polyp removal
- Identify all injuries and conditions to correctly code for multiple significant trauma
- Expirations on standing orders
- Developing a Fall-Prevention Program
- Clinically Speaking: Accidental puncture laceration
- Clarifying status indicator ’S’ and ’T’ procedures
- Searched