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

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Brett: Chere: Laurie Weber: Chere: Laurie Weber: Chere: Laurie Weber: Chere: Laurie Weber: Brett: Chere: Laurie Weber: Operator: Vicki Graham: Brett: Vicki Graham: Chere: Brett: Mary Muchow: Actually I’m going to throw that over to Chere. http://www.wpsmedicare.com Well, but are they talking about claims, like, if a patient is seen by two doctors within the same group, it looks at the tax ID. It looks at the tax ID not the… Yes. …billing group NPI. No. No. Right. Just the tax ID. So if two doctors under the same tax ID saw that patient, that’s considered concurrent care. OK. That answers my question. Provided they’re the same specialty. Right, right. Thank you. Your next question comes from the line of Vicki Graham. Hi. I have an ambulance question about return transfers. We live in a very super rural area, and say, we need to transfer a patient for a broken hip. We transferred him to see an orthopedic surgeon. They have their surgery and then they want us to transfer him back to our facility. Is that covered by Medicare This is Brett. Let me just kind of ask you a few questions, we might have to research this one. Now, when you referred to your facility, what do you mean by that Are they coming from a nursing home Are they coming from their home to the surgery What’s the origin From our hospital. We have a small hospital, and we transport to a larger hospital that has a specialist or surgeon. So will they pay for from the larger facility to a lower level of care No. Generally, we only cover to the hospital where there’s a surgeon who was able to provide those services, then they should be provided there. But if the patient’s preference to go to a different site, then it would be the patient’s responsibility for that transport. Nearest appropriate facility. 20
Vicki Graham: Operator: Richard Farley: Brett: Richard Farley: Brett: Richard Farley: Brett: Richard Farley: Brett: Mary Muchow: OK, thank you. http://www.wpsmedicare.com Your next question comes from the line of Richard Barley. Excuse me, Farley. Hi, I have two quick questions. There’s a code for preparation of antigens for allergen immunotherapy, 95165, and we’ve had an allergist for about three years and we haven’t had any problems with this code until this year. There seems to be a medically unbelievable edit that set it like 30 and we never prepare antigens less than 36 doses. So I’m not sure if this is a mistake or how do we address that, or this seems like the medically unbelievable edit is set medically unbelievably low. This is Brett, Medical Review. Are you doing the drops He prepared a little vial and then take (inaudible) out of that for 36 doses. And then… It is typical. Does the patient take those sublingually No, this is for injection. We’re probably going to have to research that one. There is information published on the CMS National Correct Coding Initiative webpage that includes information about medically unlikely edits. It does provide for you there on that CMS web page a contact. If you disagree with an MUE that is established by and published by the CMS contractor, publish them on the CMS web page. Remember that not all MUEs are indeed published, but there is a listing of the contractor that you can go to, to present your case if you will. If you need that information, I don’t have a computer here in the room. I can take your number and I can give you a call, Richard. Richard Farley: OK. Yes, it’s (563) 589-4058. Mary Muchow: Richard Farley: OK. Then my other question is about this – and I’m not sure where this is, and the medical director sort of forwarded to me but I’m not sure if this has been fixed or not. But there was this talk about how you are in PECOS and if you don’t list the referring provider just right, your claims are going to be denied and I just want to give an example of why this is so difficult for us. It seems pretty simple on the surface. Then if you can give the right place to go to get the proper list. But we were looking for a referring physician from the University of Iowa. We’re in Iowa 21
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09/11/12 Ask-the-Contractor Teleconference (ACT ... - WPS Medicare

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