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Thread: Cms - Does anyone know for sure if CMS requests

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    AAPC: Back to School
    Quote Originally Posted by kevbshields View Post
    If CMS is requesting a specific service be submitted to it in a specific format and you have that request in writing, you should provide it to that payer in that format.

    While I do not enjoy altering stated coding guidelines myself, it is sometimes necessary from a compliance standpoint. For instance, it doesn't have to be "written" somewhere that you attach a "GA" Modifier to a service for which you have a signed ABN (we're talking a Medicare Bene here), it is simply sound and compliant coding.

    I believe it is the responsibility of the practice/physician once the agreement is made to participate in the Medicare program. The Federal Register searches I've done are not showing me exactly what I need to see.

    Hopefully someone else will have the specific document or mention of it.

    Of course, when we say that CMS guidelines supercede stated guidelines elsewhere, it would only apply to either Medicare or Medicaid patients--dependent upon the specific situation.

    Good luck.
    Kevin, the documents you need would be in the service specific manuals such as the Inpt, OPPS, CORF/ORF and Part B services chapters under Pub 100-2 Benefit Policy Manual at www.cms.hhs.gov/manuals. How to code those claims and submit them on a UB-04 or CMS 1500 would be in Pub 100-4 Claims Processing Manual; service specific chapter. Various Change Requests (CRs) that come out frequently also redefine coding specifics for Medicare as regulations change.
    Medicare does occassionally "redefine" CPT codes for their purposes because the Medicare/Medicaid benefit does not equally crosswalk to a private payor source.
    These manuals are great resources for anyone who bills Medicare; and should be "bookmarked"
    Keep in mind that region specific contractors may also "clarify" regulations for Medicare coverage and coding in their Local Coverage Determinations (LCDs) and those are found on your FI/Carrier/DME MAC web site (who ever your contractor is)...check with them and look under "Medical Policy" on their web site for their instructions
    Hope this helps
    Last edited by RackeSRN; 12-05-2007 at 03:38 PM.

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