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MAC Announces Prepayment Probe Review for Outpatient HBOT
Medicare Administrative Contractor Palmetto GBA® will be performing prepayment service-specific probe medical review on outpatient claims for hyperbaric oxygen therapy (HBOT - Healthcare Common Procedure Coding System code G0277) in North Carolina, South Carolina, Virginia, and West Virginia. This probe is based on internal data analysis and prioritization, which identified code G0277 as a major risk. Probe edits will be set in North Carolina, South Carolina, Virginia, and West Virginia, and will select a sample of 100 claims from each state.
Providers who receive an additional documentation request (ADR) must submit the requested medical record information within 45 days of the date listed on the ADR using one of the following methods:
- The preferred method for responding to an ADR is via the eServices Portal. (Visit www.palmettogba.com/eservices for more information.) To participate, the provider must have a signed electronic data interchange agreement on file with Palmetto.
- Electronic submission of medical documentation mechanism. For more information, visit www.cms.gov/esmd.
- Medical records may be submitted on compact discs or digital videodiscs to Palmetto. Use the correct file format of tagged image file format or portable document format.
- Fax: 803-699-2432 or mail to: Palmetto GBA, JM Part A Medical Review, Mail Code: AG-230, P.O. Box 100238, Columbia, SC 29202-3238.
Providers should ensure the accuracy of their billing and send the following documentation when responding to the ADRs: documentation to support care is being provided under the care of a physician; documentation to support the entire body was exposed to the oxygen under increased atmospheric pressure and administered in a chamber; documentation to support beneficiary is being treated for a covered ICD-10-CM diagnosis code that meets one or more of the 15 approved Medicare conditions listed in the National Coverage Determinations Manual Section 20.29 – HBOT; diagnostic test results to confirm the diagnosis for the condition being treated; signed and dated physician’s order; clinical documentation of history, examination findings, treatment parameters, failed treatments, expected outcomes; progress notes/plan of care that includes: treatment type, number of treatments, length of treatment, goals, and progress updates with response to treatment; and other pertinent documentation to support medical necessity. For more information, call 855-696-0705.
MACRA Requires SSN Removal Initiative
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires the Centers for Medicare & Medicaid Services to remove Social Security numbers (SSNs) from all Medicare cards by April 2019. A new, randomly generated Medicare Beneficiary Identifier (MBI) will replace the SSN-based health insurance claim number on new Medicare cards for transactions such as billing, eligibility status, and claim status. Practitioners can prepare for this change by visiting www.cms.gov/medicare/ssnri/index.html. Pay particular attention to information related to:
- transition period;
- characteristics of the MBI; and
- how to obtain the MBI.
It’s also time for clinicians to review their practice management systems and business processes to determine any changes that are needed to use the new MBI.
Updated Evaluation & Management Services Guide Released
The Centers for Medicare & Medicaid Services has updated its Evaluation & Management Services guide.
Wound care professionals can learn about:
- medical record documentation;
- evaluation and management billing and coding considerations; and
- 1995 and 1997 documentation guidelines.
For more information and to review the publication, visit www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlngeninfo/index.html
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