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National
Government Services, Inc.
Medicare Monthly Review Part A and B |
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A
Combined Part A and Part B Newsletter |
MMR-2007 08B, August 2007
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Claims Processing Change for Services Submitted with the Health
Professional Shortage Area (HPSA) Modifiers QB or QU for Claims
with Dates of Service on or After January 1, 2006 (5629)
Provider Types Affected
Physicians submitting claims to Medicare Part A/B Medicare Administrative Contractors
(A/B MAC), or carriers for services rendered to Medicare beneficiaries in health
professional shortage areas
Provider Action Needed
Impact to You
For dates of service on or after January 1, 2006, when a modifier is required
to bill for the HPSA bonus, use the AQ modifier for physician
services provided in HPSAs. Claims will be returned as unprocessable
if submitted with the QB or QU modifiers, when submitted for dates of
service on or after January 1, 2006.
What You Need to Know
Make certain that services eligible to receive a HPSA bonus
for dates of service on or after January 1, 2006, are billed
with the AQ modifier, when
a modifier is required.
What You Need to Do
Make certain that your billing staffs are aware of these changes.
Background
Under certain circumstances, it is necessary to include a modifier on a claim
in order to receive a HPSA bonus payment. The QB and QU modifiers are the
appropriate modifiers to be submitted for claims with dates of service prior
to January 1, 2006. The AQ modifier is the appropriate modifier to
be used for dates of service on or after January 1, 2006. Per direction
from the Centers for Medicare & Medicaid Services (CMS), some Medicare
contractors allow claims submitted with the QB and QU modifiers with dates
of service on or after January 1, 2006 to be submitted and processed, though
no bonus payment is made as the correct modifier has not been submitted.
According to Health Insurance Portability and Accountability Act (HIPAA)
regulations for transactions and code sets, as found in 45 Code of Federal
Regulations (CFR) 160, providers must include valid codes and modifiers,
as derived from the standard transaction code sets, on their incoming claims
submitted to Medicare. Therefore, allowing claims with inappropriate modifiers
to be accepted into the Medicare claims processing system constitutes a violation
of the HIPAA standard transaction code sets.
In order to comply with HIPPA regulations and allow claims to be forwarded
successfully to supplemental payers, as of October 1, 2007, Medicare
will no longer accept claims submitted with the QB or QU modifiers for invalid
dates of service. Claims must be submitted with the correct modifiers
for the correct dates of service in order to be processed.
Additional Information
For complete details regarding this Change Request (CR) please see the official
instruction (CR5629) issued to your Medicare carrier, or A/B MAC. That instruction
may be viewed by going to http://www.cms.hhs.gov/Transmittals/downloads/R1275CP.pdf  on
the CMS Web site.
If you have questions, please contact your Medicare carrier, or A/B MAC,
at their toll-free number which may be found at: http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip  on
the CMS Web site.
Additional information on the HPSA bonus and the physician scarcity area
bonus can be found at http://www.cms.hhs.gov/HPSAPSAPhysicianBonuses/01_overview.asp  on
the CMS Web site.
The Guide for Using the HPSA/PSA Web Page can be viewed by going to
http://www.cms.hhs.gov/HPSAPSAPhysicianBonuses/Downloads/instructions.pdf on
the CMS Web site.
Disclaimer
This article was prepared as a service to
the public and is not intended to grant rights or impose obligations. This
article may contain references or links to statutes, regulations, or other
policy materials. The information provided is only intended to be a general
summary. It is not intended to take the place of either the written law or
regulations. We encourage readers to review the specific statutes, regulations
and other interpretive materials for a full and accurate statement of their
contents.
MLN Matters Number: MM5629
Pub. 100-4, Transmittal# R1275CP, CR# 5629
Related CR Release Date: June 29, 2007
Effective Date: January 1, 2006
Implementation Date: October 1, 2007
| CPT five-digit codes, descriptions, and other data only are copyright 2006 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS clauses apply. |
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