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NP denials after change in Medicare carrier

  1. Question NP denials after change in Medicare carrier
    Medical Coding Books
    Hi All,

    I am a medical coder in the state of WI and I have a NP who performs minor surgical procedures (flex. sigmoidoscopy, anoscopy, G-tube changes, etc.)
    NP's are allowed to perform these procedures with proper training in our state and our old Medicare carrier paid for her claims. Now that we have switched to NGS Medicare, we are receiving denials for all procedures that she performs stating she is not allowed to do so. We have appealed and given them information showing that she is allowed to do these procedures. They are still denying our claims.

    Is anyone out there running in to this situation as well? If so, have you been able to get NGS to pay? Does anyone have any suggestions on anything else that we could try?

    Thanks in advance.

  2. #2
    Default
    I never billed a NP for these services, but I used to for a MD. Since he did them as outpatient hospital they were billed to Part B Medicare and not NGS. Everything done in our clinic goes to NGS. You didn't state whether you were doing it in an office setting or outpatient hospital. Don't know if this helps or not

    Deb

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