Results 1 to 2 of 2

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
    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


Similar Threads

  1. Can the insurance carrier change your code?
    By dcrossman in forum Billing/Reimbursement
    Replies: 0
    Last Post: 06-13-2014, 11:39 AM
  2. CCI Edits -Non-Medicare Carrier Rules
    By sbellm in forum Billing/Reimbursement
    Replies: 1
    Last Post: 12-05-2012, 10:34 AM
  3. Medicare denials
    By Thouvenel in forum Medicare Regulations
    Replies: 2
    Last Post: 05-25-2012, 09:42 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.