Archive for March, 2013

CMS Revises Claims Policy For Name Mismatch

The Centers for Medicare & Medicaid Services (CMS) released a new transmittal reverting to its pre-Oct. 1 policy of handling claims where the Health Insurance Claim Number (HICN) does not match the beneficiary name associated with that HICN. The policy that went into effect on Oct. 1 required an exact match of the beneficiary’s first initial and the first six letters of the last name (including special characters) or the claim would be returned.  It is hopeful the new edit, effective April 1, will resolve this issue.

The new policy  changes the current CWF and shared system processes so that if there is a HICN and name mismatch within CWF, the submitter will receive the information it originally submitted when the claim is returned. CMS is also eliminating from §20.2.2.6 the bullet point that required the Host to return what it believed to be the proper information.

Click here to download the policy R2670CP in PDF format.

Medicare Place Of Service Change Effective April 1

A new policy addressing place of service (POS) coding for services paid under the Medicare physician fee schedule is set to go into effect on April 1, 2013.

 The policy will require that the POS code used by physicians or other suppliers will be the setting where the Medicare beneficiary received the face-to-face service with two exceptions for those services when the patient is receiving inpatient care or outpatient care from a hospital; the correct code will be either inpatient hospital (POS code 21) or outpatient hospital (POS code 22), regardless of where the face-to-face service occurred. The POS policy also incorporates existing policy that requires the location where a service is actually performed to be included on the claim.