Part B Insider (Multispecialty) Coding Alert

Published on Thu Oct 18, 2012 PDF

Plus: HIPAA breach costs one practice $1.5 million.

Consolidated billing is difficult as it is, but when a MAC makes an error in processing claims, those issues can balloon and create problems for your cash flow. Unfortunately, one MAC has discovered such a problem, but on the bright side, the contractor is already trying to fix it.

NGS Medicare, a Part B provider in Connecticut and New York, announced on Oct. 9 that it was incorrectly denying some services that are excluded from consolidated billing. On those claims, the reason code is "109: Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor."

Although NGS notes that the problem has been happening for nearly a year, it also admits that "the issue remains unresolved." NGS intends to notify impacted practices once the problem is rectified.