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05/31/13

Managing Claim Submission Errors Teleconference

First Coast Service Options, Medicare Administrative Contractor for the state of Florida, will be hosting a webcast on Tuesday, June 25, 2013 from 11:30AM-1:30PM on managing claim submission errors for private practices. For additional information and to register, click HERE.

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05/31/13

Cigna to Conduct Probe Medical Review in Kentucky

On May 31, 2013, Cigna Government Services announced they will implement a service specific probe edit for type of bill (TOB) 21X for Resource Utilization Group (RUG) code RUC10. They will review approximately 100 claims as part of this probe review. For additional information and what documentation to submit if you have records requested, click HERE.

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05/28/13

WPS Retiring SLP LCD

Wisconsin Physician Services, Medicare Administrative Contractor in Indiana and Michigan, will be retiring their speech-language pathology local coverage determination effective July 15, 2013 for both private practices and non-private practice settings.

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05/26/13

Change to Payment Liability for Therapy Cap Denials

Section 603(c) of the American Taxpayer Relief Act of 2012 (ATRA) changed the payment liability for denials resulting from the outpatient therapy caps from beneficiaries to providers effective January 1, 2013. Medicare systems were not updated in time to accurately represent this change on provider remittance advices (RAs). Medicare contractors may have already processed therapy cap denials for services provided in 2013. These denials incorrectly report on RAs beneficiary liability (Group Code “PR”) when liability legally rests with the provider (Group Code “CO”). Due to differing claims processing system constraints, this inaccurate RA reporting will be corrected beginning on different

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05/23/13

Cigna Sends ADR Requests in Error

CGS mailed Additional Documentation Request (ADR) letters to Physical Therapists (specialty 65) in error in the state of Ohio. These letters were mailed from May 8-22, 2013. Physical therapists (specialty 65) who received one of these letters do not need to respond. CGS is currently identifying the affected claims and will release them for routine processing whether or not a response has been received.

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05/22/13

WPS To Host SNF Teleconference

Wisconsin Physician Services, Medicare Administrative Contractor for the states of Iowa, Kansas, Missouri, and Nebraska, will be hosting a teleconference on May 29, 2013 from 2:00pm-3:30PM ET on SNF same day transfers. To register, click HERE. Wisconsin Physician Services, Medicare Administrative Contractor for the states of Indiana and Michigan, will be hosting a teleconference on May 29, 2013 from 2:00pm-3:30PM ET on SNF same day transfers. To register, click HERE.

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05/22/13

Billing Social Work & Psychological Services in CORFs

The Centers for Medicare & Medicaid Services (CMS) recently updated the list of Healthcare Procedure Coding System codes billable in comprehensive outpatient rehabilitation facilities (CORF). CMS provides new information containing billing instructions for a national coverage determination (NCD) related to CORFs that was previously omitted from the Medicare Claims Processing Manual. The new instructions clarify allowed revenue codes with type of bill 75x filed with social work and psychological services provided in CORFs. Here is the link to the MLN Matters® article: MM8257

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05/21/13

Don’t Forget The KX Modifier or Else

Effective June 20, 2013, Cigna Government Services, Medicare Administrative Contractor in the states of Kentucky and Ohio, will require additional documentation be included with all Reopening request that are being submitted for the purpose of adding a KX modifier to a therapy claim. The documentation may include but is not limited to: treatment plans, history and physicals, progress notes, consult notes and reports. After this date, if the documentation is not included with the reopening request, the claim cannot be processed for an adjustment.

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