Indiana

The Office of Inspector General (OIG) of the Department of Health and Human Services advised in the 2013 OIG Work Plan that they would be reviewing Medicare payments for Incarcerated Beneficiaries. Audits conducted by the OIG have resulted in overpayments to providers across the country, including those serviced by National Government Services. As a result, CMS has charged National Government Services to begin the process of recouping identified overpayments. The first series of overpayment adjustments have generated. Overpayment letters will begin to be mailed on Monday, December 10.

Indiana Medicaid published an article August 28, 2012, regarding outpatient crossover claim denials for explanation of benefit (EOB) 264 - Date of service missing. These claims are received by the IHCP directly from Medicare, where the date of service (DOS) at the detail level is no longer required. When the claim crosses over electronically to the IHCP, the DOS is missing at the detail level, causing the claim to deny for EOB 264.

Effective August 1, 2012, the Indiana Health Coverage Programs (IHCP) has linked CPT code 80157 – Carbamazepine; free to revenue codes 301 – Lab chemistry and 309 – Lab other. Providers may bill this procedure code together with these revenue codes, for dates of service on or after August 1, 2012.

For dates of service on and after October 1, 2012, when providers submit claims for services or supplies that require an order, prescription, or referral, the submitting providers will be required to include the National Provider Identifier (NPI) of the provider who ordered, prescribed, or referred the services or supplies. The IHCP’s claims processing will monitor whether the ordering, prescribing, or referring provider is enrolled in the IHCP. Claims will deny if the ordering, prescribing or referring provider is not enrolled.