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NJPTAid Newservice Item: Medicare Claims Processing

There are several new items of interest on the Empire Medicare Services website, which can be accessed via the following link:

These items should be of interest to all who bill their Medicare claims to Carriers. There are two that we would like to call particular attention to. The first is entitled Explanation of Systems Used by Medicare to Process Your Claims. The focus of this article should be self-explanatory.

The second item is entitled Processing All Diagnosis Codes Reported on Claims Submitted to Carriers. This item discussed recently released transmittal form CMS regarding ICD-9 codes on Medicare claims. It is well- known that many claims for PT and rehabilitation services require multiple diagnosis codes to properly describe the patients receiving services. Despite this, many carriers have only recognized the first diagnosis submitted when adjudicating claims. CMS will now require Carriers to include all submitted diagnosis codes when processing and adjudicating claims.

From the Empire news item:
"The Centers for Medicare & Medicaid Services (CMS) has issue Change Request (CR) 4097, Transmittal 735, requiring that all standard systems for carrier claims process all diagnosis codes reported in the adjudication of the claim. In Chapter 26, Section 10.4, Item 21, of the Medicare Claims Processing Manual, obsolete references have been removed. This CR will be implemented in multiple phases. This is the first phase, which will include only the analysis and design.

To view the complete CR issued to your carrier, go to: on the CMS Web site."

From Transmittal 735:
"80.6 - Processing All Diagnosis Codes Reported on Claims Submitted to Carriers (Rev.735, Issued: 10-31-05, Effective: 04-01-06, Implementation: 04-03-06)
Carrier standard systems shall capture and process all diagnosis codes reported on a claim (both paper and electronic) up to the maximum permitted under the format. The CWF shall process and maintain all diagnosis codes reported to CWF on a carrier processed claim."