News From Novitas: Draft LCDs, Forms, and Errors to Avoid

Novitas Solutions is accepting comments through Nov. 5, 2015, on the draft local coverage determinations (LCDs) below.

As required by the Centers for Medicare & Medicaid Services, Novitas posts draft LCDs three times each year, typically in January, May, and September, for a 45-day open comment period. Draft LCDs are new policies or revisions that restrict and/or involve a substantive change to existing LCDs. Do any of these drafts affect your practice?

Use Current EDI Enrollment Forms

When you enroll for electronic data interchange (EDI) with Notivas or need to make a change to an existing EDI enrollment, be sure to use the most current enrollment form. 

Novitas’ EDI Services will return outdated EDI enrollment forms submitted on or after Sunday, Dec. 6, 2015. Any EDI enrollment form that displays a form revision date older than October 2015 is out of date; look for the revision date (e.g., “R10-15”) in the lower left-hand corner of the form. You can find up-to-date forms on the Novitas website. Novitas recommends that to minimize errors, you complete the EDI forms on the website, then print and fax them to the number provided on the form.

If you are already enrolled in EDI with Novitas, you don’t have to do anything. Just be sure to use a current form to make any changes to your current EDI setup. If you have questions, contact EDI Services at (855) 252-8782.

If You’ve Heard It Once …

Novitas recently published the current most common Medicare claim submission errors. In fact, these ubiquitous errors turn up year after year. The current top-six errors (followed by the explanation of Medicare benefits message number in parentheses) are:

  1. Noncovered charge/s (96) — Be sure Medicare covers a service before you bill for it.
  2. Charges exceed fee schedule/maximum allowable or contractor/legislated fee arrangement (45).
  3. Claim not covered by this payer/contractor (109) — Bill the service to a different Medicare contractor as appropriate, such as a contractor for durable medical equipment or hospice-related services, or to the patient’s Medicare Advantage plan.
  4. Duplicate claim/service (18) — Before filing a duplicate, check claim status through Novitas’ automated phone system at (855) 252-8782 to see if another claim was paid or is still in process. Allow enough time for a claim to process before submitting a duplicate.
  5. The procedure code is inconsistent with the modifier used or a required modifier is missing (4). (Refer to the 835 Healthcare Policy Identification Segment [loop 2110 Service Payment Information REF], if present.)
  6. Claim/Service lacks information needed for adjudication (16) — Verify required claim information before filing.

Sign Up Now for TMA’s Medicare 2016 Seminar 

Once again, big changes are coming to Medicare. Although the Sustainable Growth Rate (SGR) formula is now history, the bill that repealed the SGR is likely to accelerate the movement toward value-based payment systems — for all physicians. Sooner rather than later, you’ll have to prepare to participate in a Merit-Based Incentive Payment System or an alternative payment model system. Doing nothing may cost you. TMA’s day-long Medicare Now and Tomorrow seminar will help you develop short-term and long-term strategies to adjust so you can do what you need to do, and do it right. Registration is open now for the seven-city tour.

Visit the TMA Medicare Resource Center for tips, tools, and information about Medicare.

Published Oct. 12, 2015

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Last Updated On

April 20, 2018

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