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
- Note similarities and differences between HCPCS, CPT® codes
- Q&A: Primary, principal, and secondary diagnoses
- CDC alert: Screen for international travel as Ebola cases increase
- Differentiate between types of wound debridement
- Complications from immobility by body system
- The consequences of an incomplete medical record
- Practice the six rights of medication administration
- Nursing responsibilities for managing pain
- OB services: Coding inside and outside of the package
- E-mailed
-
- CDC alert: Screen for international travel as Ebola cases increase
- Capturing start and stop times for infusions
- Differentiate between types of wound debridement
- Life Safety Code Q&A: Ambulatory care soiled utility room
- Leadership training for charge nurses
- Helping Charge Nurses understand their leadership role (Part 2 of 3)
- Five ways to safeguard your patients' valuables
- Developing a Fall-Prevention Program
- Coding, billing, and documentation tips for teaching physicians, interns, residents, and students
- Coding tip: Watch for different codes for SI joint injections
- Searched