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Wiki NP Claim Denied from CGS...help!

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Karen325

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I have a claim for a subsequent hospital visit 99232, that has been denied by CGS Medicare for the following reason, "CGS Medicare will not pay for a NP on the same day as another doctor that also saw the patient. Regardless of speciality or group. CGS Medicare considers the NP trained in overall medicine & is similar to all specialites."

The other provider who billed on this day is a Neurologist and there are no duplicated diagnosis between the two providers. The NP billed for services related to the care of the PCP and the Neurologist billed for issues regarding the patient's altered mental status.

We have never had an issue before with CGS not paying for NP hospital visits. Does anyone have a similar situation or know how we can get this claim paid?

Thank you!
 
I deal with Highmark Medicare Svs and always appeal with the "Specialties".. If the first level still denies, the I go to the 2nd level..and they usually will allow and pay. Find out about their policies...

Betsy
 
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