NARHC Forum
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| 9/10/2020 @ 5:59:00 PM
Post 11 of 47
Contributor: Nathan Baugh, National Association of Rural Health Clinics
Yes, as Patty said, it means you cannot bill these codes with modifier CG as the main reason for the RHC encounter. 9/11/2020 @ 8:53:00 AM
Post 12 of 47
Contributor: Jan Oberlin, Dickinson County Healthcare System RHCs
Nathan,
Thank you for further pursuing this issue with CMS. I think they really need to re-think the "list." Per CMS rules, Medicare Claims Processing Manual, Chapter 12, Section 40.1.C. every procedure (whether major or minor) includes an "inherent" E/M component and , as such, you may not report a separate E/M service on the same date of service. If they exclude these procedures from our AIR payment then how are we to be reimbursed for the "inherent" E/M component (face to face visit) that is included in the procedure? It would be tempting to bill an additional E/M service with modifier CG just for the purpose of receiving our AIR payment, but totally inappropriate. Not only would that be incorrect coding, but it would also cause the patient 20% coinsurance to be inflated. Thank you, Jan Oberlin, CCS-P, CPMA Provider Coding Compliance Coordinator Dickinson County Healthcare System P 715.528.4775 ext 3016 Jeanette.oberlin@dchs.org Confidentiality Notice: This e-mail communication and any attachments may contain confidential and privileged information for the use of the designated recipients named above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its contents is prohibited. As required by federal and state laws, you need to hold this information as privileged and confidential. This message may contain Protected Health Information (PHI). PHI is personal and sensitive information related to a person's health care. It is being emailed to you after appropriate authorization from the patient or under circumstances that do not require patient authorization. You, the recipient, are obligated to maintain it in a safe, secure and confidential manner. Re-disclosure without additional patient consent or as permitted by law is prohibited. Unauthorized re-disclosure or failure to maintain confidentiality could subject you to penalties described in federal and state law. If you are not the intended recipient, or the employee or agent responsible to deliver it to the intended recipient, you are hereby notified that any disclosure, copying or distribution of this information is Strictly Prohibited. If you have received this communication in error, please notify the sender and destroy all copies of this communication and any attachments. Dickinson County Healthcare System, 1721 S. Stephenson Ave. Iron Mountain, MI 49801, www.dchs.org 9/11/2020 @ 8:54:00 AM
Post 13 of 47
9/11/2020 @ 9:33:00 AM
Post 14 of 47
Contributor: Shirley Gamble, Sterling Medical Center
Nathan,
Thanks for your reply. Yes, I am aware about the carve out issues but was grasping at straws. One of my providers performed a laceration repair 12001 (which couldn't/shouldn't have to wait until after RHC hours or necessitate an ER visit ) It was a fairly straight forward repair so questionable that an E/M code would be appropriate since the procedure includes a minimal E/M evaluation. Just seems this is discriminatory against RHCs when non RHC providers can get paid for taking care of their patients by performing these services for their patients. I am really struggling with how most of the services on the list can be determined by a Committee or group of persons as not qualifying for reimbursement when done by an RHC provider. You stated in one of your previous posts that we may have to appeal code by code. Is this something I can do for this claim? I am considering contacting my congressman about this. Anything else I can do? I now have a handful of claims that were denied as not qualifying for CG, therefore unable to be paid. *Shirley L Gamble, CPC* Clinic Coding Manager Sterling Medical Center 239 N Broadway Sterling, KS 67579 620.278.2123 Main 620.278.2712 Fax On Thu, Sep 10, 2020 at 5:01 PM NARHC News wrote: > 9/11/2020 @ 10:04:00 AM
Post 15 of 47
Contributor: Patty Harper, InQuiseek Consulting
It's difficult to understand why most of these codes are conflicted. If RHCs are required to be able to provide emergency care, then a laceration repair makes sense especially in rural areas-farming or ranching injuries, work-related injuries, sports injuries. It's great to know that we have a way to challenge this. I believe the 20% coinsurance defense would be good because we could be saving beneficiaries coinsurance if we weren't required to have an unnecessary E & M.
Patty Harper, RHIA, CHTS-IM, CHTS-PW, CHCR Healthcare Consultant/Principal 318-243-2687 (Cell) 866-855-0683 (Fax) 940 Ratcliff Street Shreveport, LA 71104 The information contained in this transmission may contain privileged and/or confidential information, including patient information protected by federal and state privacy laws. It is intended only for the use of the person(s) named above. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution, or duplication of this communication is strictly prohibited. If you are not the intended recipient, please contact the sender by reply email and destroy all copies of the original message. 9/18/2020 @ 11:41:00 AM
Post 16 of 47
Contributor: Shauna Stokes, Lakewood Clinic Staples
If a visit does not qualify as stand alone, for example 11721, can we change it to an E/M code and remove the procedure code for the visit completely? 10/15/2020 @ 12:31:00 PM
Post 17 of 47
Contributor: Julie York, Marengo Family Medical Clinic
Have there been any updates from CMS on the HCPCS conflict 11721? What are others doing in the meantime?
Julie York Clinic Billing Supervisor Compass Memorial.org 10/15/2020 @ 4:18:00 PM
Post 18 of 47
Contributor: Diane Condon, Mitchell County Regional Health Center
Our HIM Director listened in on the WPS foot care webinar and asked about the issue with 11721 and the response is below. I'm also interested if RHCs have any other option to be reimbursed for this code as well as other codes on the conflict list.
CMS updates the Inpatient/Outpatient Code Editor (I/OCE) on a quarterly basis. The latest update removed procedure code 11721 from the list of qualifying visits. This means as of July 1, 2020, you would no longer submit this procedure code to receive the All-Inclusive Rate (AIR) payment. Charges for this procedure code would instead be part of your cost report. You can find more information in the resources below. OCE Quarterly Release Files https://www.cms.gov/Medicare/Coding/OutpatientCodeEdit/OCEQtrReleaseSpecs Change Request 11792 Transmittal 10165 dated June 5, 2020 Version Updates https://www.cms.gov/files/document/r10165cp.pdf Diane Condon Director of Patient Financial Services Mitchell County Regional Health Center Phone: (641) 732.6074 Fax: (641) 732.6080 Email: condond@mercyhealth.com [cid:image003.png@01D50B2B.F6D39BA0] Confidentiality Notice: This e-mail, including any attachments is the property of Trinity Health and is intended for the sole use of the intended recipient(s). It may contain information that is privileged and confidential. Any unauthorized review, use, disclosure, or distribution is prohibited. If you are not the intended recipient, please delete this message, and reply to the sender regarding the error in a separate email. 10/16/2020 @ 12:08:00 PM
Post 19 of 47
Contributor: Jackie King, ArchProCoding
Please note that Nathan and NARHC are working on this issue at the Federal level. We have provided him with examples of claims and denial reasons. I don't believe there has been any update (unless I missed it).
Thank you, Jackie [cid:image001.png@01D579EB.4BFCECC0] Jackie King, MSHI, CPC, COC, RH-CBS Director of Compliance & Clinical Informatics, HIM Consultant Illinois Critical Access Hospital Network (ICAHN) | 1945 Van's Way, Princeton, IL 61356 P 815.875.2999 | F 815.875.2990 | jking@icahn.org 11/17/2020 @ 10:17:00 AM
Post 20 of 47
Contributor: Deyon Suchla, Eide Bailly - South Dakota
Just checking in to see if anyone has been successful when appealing these codes with supporting documentation to their MAC? ( including 11750, 12001, 20600) |
