09/11/12 Ask-the-Contractor Teleconference (ACT ... - WPS Medicare

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issue after the day of insertion. The CCI only talks about the concurrent dates. http://www.wpsmedicare.com Mary Muchow: Operator: Lisa Armstrong: Mary Muchow: Male: Dr. Boren: Male: Dr. Boren: Male: Dr. Boren: Mary Muchow: Operator: Jim Williams: May Muchow: Jim Williams: Same provider, same date of service, same encounter. Your next question comes from the line of Lisa Armstrong. Hello. Hi. We have a question regards to ambulance transports and the day of hospital admit. If the patient arrived at hospital A to the emergency room, is admitted by the emergency room division. He writes the order according to the Medicare manual and the patient is then transferred by ambulance to another hospital that shares the same provider number after those orders are written but it’s the same date. Is that a Part A billable or is that a Part B billable We’d have to look that up. But I don’t think it’s payable because when it’s considered to be like you took the person from one floor of the hospital to another floor. So it would the responsibility of the facility not Medicare. Right. If it’s the same provider number, that is no different than when you take them from the emergency department to CAT scan or something as far as we’re concerned. I don’t think there’s any other way of looking at it if it’s – sometimes, we have situations where you have big campuses and you could have a different provider number on different parts. But that’s still an inter – it’s the hospital to self transfer, not to another facility Okay, next. Even it – because it’s – after the orders for admit are written, it becomes the facility’s responsibility. Correct It’s in the – if the person is in the emergency department and he is going to another place in the hospital, it’s the same provider number. OK. Your next question comes from the line of Jim Williams. Hi. Hi. I have a question and it might have been partially answered by someone from another field earlier, but we are an optometrist office. I noticed one of the – we haven’t gotten any rejections yet from Medicare but specifically on procedure code 92250 which is a fundus photography. It looks like the LCD got changed and it got put under a low vision coverage, I guess, which I believe is the 32007. Have you had any feedback on how that procedure 16
code got moved under low vision services or not at this point Does any of the make sense http://www.wpsmedicare.com to you Bonnie: Jim Williams: Dr. Boren: Jim Williams: Dr. Boren: Jim Williams: Dr. Boren: This is Bonnie. The 99250, the fundus photography, is payable for more than what’s in the low vision, of course and that’s why you’re not getting any denials. Yes. And we haven’t gotten any from you all and we don’t have any problems with Medicare or with WPS specifically.” We’ve had a couple of – oh, come on, brain think – Humana and Medicare replacement policies that have refused to pay that and said, “OK.” You know they’re saying that the fundus photography falls under low vision services and to check back with our Medicare carrier for that LCD. Like I said, we’ve been getting paid on it and I just, you know, while we’re doing this, I know that changed on 8/20. I’m looking at my newest remittance advice and I see that we’ve gotten paid for it on, you know, date of service 8/24. So I don’t know if something is out of whack with the Humanas of the world and the Medicare replacements. How would you go about, you know, changing that or… But if the problem is not with us. Right. That I’ve enough trouble doing my own job without trying to do the job for Humana company, so… Yes and that’s just it. You know, they’d say, “OK, go back to your Medicare provider or your Medicare carrier" and we don’t have any problem whatsoever with our Medicare. They’re still being paid through because the diabetic code is the macular degeneration code, it’s a glaucoma code, but they’re disallowing on all those other ones and I know that’s not WPS’ problem, but they keep pointing it back at our carrier. So I guess we’ll just kind of go their chain of command and – but I didn’t know if you guys took that code out of general usage and just lumped it under that, you know … It’s very difficult to have any specific CPT code in two separate policies. Because what happens is you cannot send out a denial then based on the policy number because the computer sees two different policies with that CPT code. So I’m not familiar with any contractor that has a CPT code that is in two separate policies. I suppose it could be – I just can’t think of any because it becomes a real systems issue when that happens. Jim Williams: Yes and I guess I was just worried that that’s what this would become. Because of this fundus photography got pulled under the 32007 ad I guess I’m just trying to read into it and say, “OK, if that is under that LCD now and we go down and see the ICD 9 codes that support the necessity, they’re all a low vision code.” If we look at that particular LCD. 17
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Page 3 and 4: for a new pricing on the influenza
Page 5 and 6: Mary Muchow: Operator: Mary Muchow:
Page 7 and 8: Dr. Boren: Natalie Murphy: Dr. Bore
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09/11/12 Ask-the-Contractor Teleconference (ACT ... - WPS Medicare

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