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JSM-08186  Instructions for Processing Claims Incorrectly Editing for an Operating Physician

Instructions for Processing Claims Incorrectly Editing for an Operating Physician

All fiscal intermediaries (FI) and Part A and Part B Medicare administrative contractors (A/B MAC)

CMS Joint Signature Memorandum (JSM)-08186 (February 27, 2008)

Currently, some Non Outpatient Prospective Payment System (Non-OPPS) outpatient bills (13X and 83X) are incorrectly editing with reason code 32151. The claims are being returned to the provider (RTP) requesting the operating physician information be present, despite the fact there are no surgical services on the claim. We are requesting that providers to add attending physician information to the operating physician fields to any such RTP claims that are incorrectly editing with the above reason code.

For any claims that are currently in suspense, contractors will add the operating physician information to the claim by duplicating the attending physician information; this includes the National Provider Identifier (NPI), in lieu of returning those claims. Contractors will continue this procedure until the successful installation of the April 2008 Integrated Outpatient Code Editor (IOCE).

 

 

 

Posted: 03/04/2008

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