Virginia

Follow Us

Palmetto MoPath Claims Submission Guidelines

Mon, 2013-05-20 12:26

Because the MoPath Tier 2 CPT code descriptions do NOT identify the specific genes tested, laboratory providers that have not obtained a unique 5-digit ID through Palmetto GBA or McKesson Dex must provide additional information until an ID is obtained. As per the MolDx Program, claims submitted in J1 without a unique ID will be denied. Claims submitted in all other areas administered through Palmetto GBA should reference the “Required Text,” Column 3, to submit the information required for claim reimbursement. Column 3 “Required Text” lists key components needed to adjudicate the claim.

Reimbursement error impacts certain professional Medicare claims

Mon, 2013-05-20 12:05

A reimbursement error caused coinsurance amounts to be reduced by 2 percent on a number of professional claims for beneficiaries enrolled in Anthem Medicare Supplemental plans (alpha prefix YTM).  The reimbursement error resulted in a shortage in payment for certain Medicare Supplemental claims with dates of service on or after April 1, 2013.

Palmetto J11 Molecular Diagnostic CPT Codes Claim Submission Guidelines

Thu, 2013-02-28 11:33

Effective immediately, Palmetto J11 will require lab providers that submit claims for Molecular Diagnostic CPT codes, to include additional documentation so they can identify the provided service. For services that require more than one claim line, the additional information must appear on each line used to report the service. Additional information may be entered in the comment/narrative field. This information will be used to determine the price and the coverage for the service. If available, lab service providers may use the MolDx ID for the specific test.

Palmetto J1/J11: New Feature! Part B Claims Processing Issues Log (CPIL)

Thu, 2013-02-28 11:37

Palmetto GBA is pleased to announce the implementation of their new Claims Processing Issues Log (CPIL). The log lists current system-related claims processing issues. These issues have been reported to CMS and/or the Multi-Carrier System (MCS). This new option will conveniently allow you to research major issues affecting the provider community before contacting the provider contact center. The issues are identified by stand alone articles and will be updated as needed.

Palmetto J1 88305 Prostate Biopsy Frequency denying incorrectly

Thu, 2013-02-28 11:40

Claims submitted with CPT 88305 for Prostate Biopsy Frequency were denying incorrectly. The claims affected were processed on 11/14/2012 for dates of service on or after 1/1/2012. The issue has been resolved on 1/22/2013 with mass adjustments to the affected claims completed on 1/10/2013.

Medicare Part A and Part B MAC for Jurisdiction 11; comprised of North Carolina, South Carolina, Virginia and West Virginia. Medicare Part A and Part B MAC for Jurisdiction 1; comprised of California, Hawaii and Nevada.

Palmetto J1 2013 MoPath Fee Schedule

Thu, 2013-02-28 11:52

Palmetto GBA has determined a gapfill allowance for the 2013 MoPath CPT codes. The fees were based on the detailed analysis of multiple lab applications and a standardization of the submitted stacks. All services to produce the assay result, including the work for microdissection, were evaluated and included in the listed fee. Therefore, additional services should not be submitted in addition to the appropriate CPT code for your assay. Palmetto has also included the coverage determination established during the review of available literature.

Palmetto J1 Loses Protest for Medicare Contract

Thu, 2013-02-28 11:56

On January 18, 2013, the Government Accountability Office (GAO) announced that they denied Palmetto’s protest, awarding the Medicare contract for Jurisdiction E (previously referred to as J1) to Noridian Administrative Services. On September 20, 2012, CMS announced that Noridian Administrative Services (NAS) had been awarded the contract for the administration of Medicare Part A and Part B fee-for-service claims in A/B MAC Jurisdiction E, which was previously called Jurisdiction 1.

CHANGE NOTIFICATION TO REIMBURSEMENT POLICIES

Thu, 2013-02-28 09:55

For claims with for dates of service on or after May 20, 2013, Travel allowance services for collection of a Lab Specimen reported with HCPCS codes P9603 and P9604 are not eligible for separate reimbursement even when reported with modifier 59. The Laboratory and Venipuncture Services reimbursement policy will also be updated to reflect this change.

Improper Payments to Providers for Incarcerated Beneficiaries

Wed, 2012-12-19 14:25

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.

MolDx: 2013 HCPCS and CPT Code Changes

Wed, 2012-12-19 14:19

Effective for services performed on or after January 1, 2013, the following codes will be included in the MolDx code range and will require a unique identifier for each claim line submission:

Code Category/Description

2013 MolDx CPT Code Range

Comment

Pages

Interested In Learning More? Contact us to learn how XIFIN can help your business. Call us at (858) 436-2995 or click here to complete a brief information request form.