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News & Press: Insurance/Provider

Noridian Post 6/10/15 CMT; WIDESPREAD 98941 Review Notification

Wednesday, July 8, 2015   (1 Comments)
Posted by: Sheri Ryan
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CHIROPRACTIC MANIPULATIVE

TREATMENT; SPINAL, 3-4 REGIONS -

WIDESPREAD SERVICE SPECIFIC

REVIEW NOTIFICATION

reposted from Noridian Jurisdiction F website - https://www.noridianmedicare.com/shared/partb/bulletins/2015/301_july/chiropractic_manipulative_treatment_spinal_3_4_regions_widespread_service_specific_review_notification.html

 

CMS is required by the Social Security Act to ensure that payment is made only for those medical services that are reasonable and necessary. To meet this requirement, Noridian Part B Medical Review (MR) analyzes national and local data in conjunction with the findings from the Office of Inspector General (OIG) and other CMS contractors such as Comprehensive Error Rate Testing (CERT) and Recovery Auditor (RA) to identify atypical billing. After data analysis, MR must verify if billing problems exist through claim reviews to validate provider compliance with Medicare coverage as well as coding and billing guidelines. If issues are identified, MR then determines the severity of problems and develops interventions to correct the problem.

Effective May 28, 2015, Noridian will initiate claim sampling from providers and suppliers who bill for the following services:

  • CPT ® 98941: Chiropractic Manipulative Treatment; spinal, 3-4 regions

Your facility will be notified of the selected claims per the normal Automated Development System (ADS) process. The provider agreement to participate in the Medicare program requires the submission of all documentation necessary to support the services billed on the claim. All applicable documentation requested needs a copy of the ADS as a coversheet. Records should be mailed (hardcopy or CD) or faxed to Noridian within 45 days of receipt or an automated claim denial will occur. Denials may result in future provider specific complex reviews and may be appealed through the normal appeal process. Additional information for this review including a listing of references, and detailed instructions on ADS submissions may be found on the LCDs/Coverage/MR page on this page: https://www.noridianmedicare.com/partb/coverage/service_specific_review.html
See the documentation requirements for each review along with references on the following page:https://www.noridianmedicare.com/partb/coverage/service_specific_review.html.Please review all of this information carefully and in its entirety.

View the appropriate widespread service specific review notifications at:

It is imperative that all providers check and review the above website on a regular basis for further updates and notification of the implementation of further Widespread Probe reviews.

Posted June 10, 2015

Comments...

Sheri Ryan says...
Posted Thursday, July 30, 2015
Dr. Ron Short posted this on his website http://www.chiromedicare.net/ Noridian Review of 98941 "Last month I stated that Noridian is conducting a review of 98941. In response to a request from one of the state associations I developed a handout on how to respond to a request for records. I will make this handout free to you and you can forward it to your state association for them to pass around for free." You can download it at http://www.chiromedicare.net/wp-content/uploads/2014/10/How-to-Respond-to-a-Request-for-Records.pdf

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