Cath Lab Digest

      1. Duplicate claims
      2. The need for this service was not supported on this claim
      3. Medicare eligibility not in effect when services were rendered
      4. Service denied/reduced because this service is not payable separately
      5. Medicare is secondary payer on this claim
      6. This service is part of another service performed on the same day
      7. Not payable, service part of another service performed on the same day
      8. Service not considered, requested information not received
      9. This item or service is not covered by Medicare
      10. This charge is included in the surgical fee

What About The Fee Schedule Allowance?

      A new year brings the usual controversy regarding the new fee schedule allowance. There had been a proposed fee reduction for 2007 of 5 percent. However, in December, Congress averted the proposed fee reduction.

      Similarly, the RVS values for each service are reviewed annually. Any changes in the RVS unit allowance for the various services were unknown as this issue went to press.

Have You Applied For A NPI Number?

      There is a new CMS (HCFA)-1500 form change. The revision to the CMS-1500 form was slated to be effective Oct. 1, 2006 (but will not be mandated until Feb. 1, 2007). The form will allow for the use of the new NPI number.

      To learn more about the new form changes, see:
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5060.pdf

      For a complete description, see: http://www.cms.hhs.gov/transmittals/downloads/R899CP.pdf

      You will need to apply for a NPI number from the National Plan and Provider Enumeration System (NPPES). This will be a universal number that all insurance companies are to use. It will follow you regardless of change in job or location. You will only be assigned one number per provider as will each group. In order to get the application process started, see the link below:
https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart.

      The implementation of the NPI number will continue to be phased in over time. However, if you have not yet applied for a NPI number, you may want to do soon. According to CMS, one must use the NPI on standard transactions with health plans, other than small health plans, no later than May 23, 2007.

      However, CMS notes that health care providers should not begin using the NPI in standard transactions on or before the compliance dates until health plans have issued specific instructions on accepting the NPI.

      Medicare’s implementation involving the acceptance and processing of transactions with the NPI has occurred in separate stages previously.

      Between May 23, 2005 and January 2, 2006, CMS claims processing systems would accept an existing legacy Medicare number and reject as non-processable any claim that included only an NPI.

      From January 3, 2006, to October 1, 2006, CMS systems accepted an existing legacy Medicare number or an NPI as long as it was accompanied by an existing legacy Medicare number.

      From October 2, 2006 through May 22, 2007, CMS systems will accept an existing legacy Medicare number and/or an NPI. This will allow for six to seven months of provider testing before only an NPI will be accepted by the Medicare program on May 23, 2007.