A wide swatch of skilled nursing facility (SNF) services, primarily for ultrasound and echocardiography, were incorrectly denied between Jan. 1 and March 14, 2011. The incorrect denials were caused by Medicare contractors not updating their claims processing system edits to include a total of 37 codes in the 76000 code series, CMS says.
TIP: You must take action to get paid for these services if you billed them this year, CMS says. From January to mid-March spans just about all of 2011 thus far. You must contact your carrier and ask them to reopen and reprocess affected claims. The agency doesn't say whether you'll be on the hook for any reprocessing fees, telling you to ask your carrier instead.
Rest assured I will be pressing CMS officials for answer on this point.
NOTE: All of the affected services with dates of service on or after March 14 should not have any problems, CMS says. March 14 is when the corrections were implemented across all carriers.
Here is a list of the codes impacted:
76519, 76529, 76536, 76604, 76645, 76700, 76705, 76770, 76775, 76800, 76801, 76802, 76805, 76810, 76811, 76812, 76813, 76814, 76815, 76816, 76817, 76818, 76819, 76820, 76821, 76825, 76826, 76827, 76828, 76830, 76831, 76856, 76857, 76870, 76872, 76873, and 76876.