Radiopharm Reimbursement

[bharper33]

We have just started having problems getting our Radiopharm's paid, even with Invoice. They've all gone to Q2 level and are now denying. They (Medicare) will not tell us why, specifically. We've done everything they've asked. Is anyone else having this problem? Any input would be greatly appreciated.

 

[CodingKing]

my only guess is they are trying to bundle them into the procedure

 

[bharper33]

That's we thought at first, but we have documentation stating that they're payable seperately

 

[CodingKing]

I found this from Novitas. Not sure if its your MAC or if its the same for all. I wasn't sure if this was the issue or not

http://www.novitas-solutions.com/we...rl-state=4rydvdmuq_4&_afrLoop=49134064433000#!

Coding guidelines

The acquisition cost should be reported in Block 19 or Block 24D of the 1500 claim form and in the 2400 loop NTE segment of an EMC claim.

Payment allowance will be made at 100% of the acquisition cost. If the acquisition cost is missing from the claim, the service will be denied. If an invoice is attached, this will be reviewed and considered for payment.

Note: the codes listed in this article are not all-inclusive and the guidelines outlined in this article apply to all diagnostic radiopharmaceutical codes.

 

[bharper33]

Yes, I just found the same thing and handed over to our A/R Lead. She asked me to post a question to see if anyone else is having the same issue. Thank you