Monthly Archives: October 2015

Noridian Update 10-28-2015

Noridian Medicare has updated their LCD for chiropractic and has also corrected the error for denied claims in Jurisdiction E (California and Nevada)

The site has been updated to reflect the changes.

There was an addition of codes M43.01 to M43.09 for spondylolysis, M50.91 unspecified disc disorder high cervical and M60.89 other myositis multiple regions

Noridian ICD-10 Update 10-27-2015

The Network has received information from several offices that they have received their first payments on the improperly denied claims by Noridian Medicare Jurisdiction E. Medicare has not officially published any notice but with these payments being reported it a appears to be corrected and back on track.

HIPAA Compliance Audits on the Horison

Recently the Office of Inspector General (OIG) for the Dept of Health and Human Services (HHS) did a study and found that the Office of Civil Rights (OCR), which has responsibility for HIPAA compliance, is not doing enough to ensure covered entities (CEs), including healthcare providers and insurers, are effectively following HIPAA requirements. They found that most activities were reactive, not proactive. The OCR agreed with report's recommendations and that they need to do more oversight actvities.

Look for more HIPAA compliance audits and enforcement activities in the coming months as funding for these activities is provided to the OCR.

Have you gotten all your compliance requirements met? This includes: establishing your policies and procedures; implementing them within your practice; ensuring everyone has taken training; ensuring all your business associates have signed a BA Agreement and have security controls in place; and performing a risk assessment; just to name the major requirements.

Make plans in the near term to address all HIPAA compliance requirements.

NOTE: All the 50 State Attorneys General office are also ramping up to do their own HIPAA compliance audits and enforcement, in addition to the OCR's activities.
See the full report at http://oig.hhs.gov/oei/reports/oei-09-10-00510.pdf

Noridian ICD-10 Update

10/19/2015 Update:

Noridian Medicare Part B for Jurisdiction E which are for the states of CA, HI, NV, American Samoa, Guam and Northern Mariana Islands has an error that they are incorrectly denying chiropractic. The LCD is being updated to contain the appropriate diagnosis codes. Once complete, Noridian will identify the claims denied incorrectly and adjust them. No action is required on the provider end at this time. These denials all indicated CO50 = medical necessity

This has not affected other states managed by Medicare or specifically Jurisdiction F Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah Washington and Wyoming.

 

https://med.noridianmedicare.com/web/jeb/fees-news/alerts-details/-/view/10525/chiropractic-claims-containing-payable-primary-diagnoses-m99-01-m99-05-are-being-denied

ICD10 Important Noridian Medicare Update

Noridian Medicare ICD10
Currently, AS OF 9:30AM PST October 15, 2015, Noridian Medicare which handles Alaska, Arizona, California, Hawaii, Idaho, Montana, Nevada, North Dakota, Oregon, South Dakota, Washington, Utah, & Wyoming are having problems with their system and are incorrectly rejecting Medicare claims that are correctly coded. They are requesting to not send claims in at this time as they will be rejected and await until the system is corrected. We will be monitoring and provide notice when the system is back up and running.

1500 Claim Form Diagnosis Reporting & ICD10- No Decimals

Reporting Diagnosis on the 1500 with ICD10 should NOT have decimals as they are implied. When reporting diagnosis in block 21 of the 1500 there is a 7 character limit and the use of a decimal will drop the final character of a 7 digit code. Therefore diagnosis on the 1500 should be reported without a decimal and simply the characters with no spacing.

Note the following examples of 3, 4, 5, 6, and 7 character codes.

R51, M545, M9900, M25511, MS134XXA

Below is the Medicare manual reference to the non-use of decimals as well as the NUCC 1500 instruction manual reference

Medicare Claims Processing Manual Chapter 26 - Completing and Processing Form CMS-1500 Data Set

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c26.pdf 

Item 21 - Enter the patient's diagnosis/condition.

For form version 02/12, it may be appropriate to report either ICD-9-CM or ICD-10-CM codes depending upon the dates of service (i.e., according to the effective dates of the given code set).

• The “ICD Indicator” identifies the ICD code set being reported.

Enter the applicable ICD indicator according to the following:

ICD-9-CM diagnosis enter “9”

ICD-10-CM diagnosis enter “0”

Enter the indicator as a single digit between the vertical, dotted lines.

• Do not report both ICD-9-CM and ICD-10-CM codes on the same claim form

• Enter up to 12 diagnosis codes

  • Do not insert a period in the ICD-9-CM or ICD-10-CM code.

For chiropractic claims-

Primary diagnosis must be segmental somatic dysfunction M9900 to M9905 however the secondary must be a neuromusculoskeletal diagnosis and form the approved list for your state.

NUCC 1500 Claim Form Manual

http://www.nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2012_02-v3.pdf

 

ITEM NUMBER 21

TITLE: Diagnosis or Nature of Illness or Injury

INSTRUCTIONS:

Enter the indicator between the vertical, dotted lines in the upper right-hand portion of the field.

Enter the codes left justified on each line to identify the patient’s diagnosis and/or condition. Do not include the decimal point in the diagnosis code, because it is implied. List no more than 12 ICD-9-CM or ICD-10-CM diagnosis codes. Relate lines A - L to the lines of service in 24E by the letter of the line. Use the greatest level of specificity. Do not provide narrative description in this field.