New Jersey Service Wide Glycosylated Hemoglobin Lab Test and Venipuncture Probe Results
New Jersey Claim Review on HCPC 83036 and 36415
In an effort to safeguard the Medicare Trust Fund by lowering the Comprehensive Error Rate Testing (CERT) paid claims error rate, Highmark Medicare Services’ Medical Review Department performs reviews and provides education based on data analysis performed to identify problem areas. The CERT program is the driver of this data analysis. The Centers for Medicare and Medicaid Services (CMS) and Highmark Medicare Services uses the information from the CERT error rate findings to determine the underlying reasons for claim errors and develops appropriate action plans to improve compliance in payment, claims processing, and provider billing practices.
Recent CERT data analysis indicated that there were claim errors in New Jersey for procedure code 83036 for Glycated Hemoglobin lab test and 36415 Venipuncture. As a result of this data analysis, Highmark Medicare Services’ Medical Review Department conducted a widespread post payment review in New Jersey on procedure code 83036 and 36415.
Our findings indicated that 53% of the claims sampled were missing documentation. The majority of the reductions/denials were based on the following:
• Physician order/referral information was missing from supporting documentation
• Submitted documentation did not support the billed diagnosis
• Requested documentation was not received in a timely manner
Please refer to the following publication for information on billing procedure codes 83036 and 36415:
• Medicare National Coverage Determination (NCD) 190.21 Glycated Hemoglobin / Glycated Protein As a result of these findings, and to assist in the reduction of the overall claims payment error rate, a prepayment review will be implemented on procedure codes 83036 and 36415, for New Jersey providers. Medical records will be requested to verify that services billed were rendered, medically necessary, adequately documented, and billed appropriately to the Medicare program. Please, do not send in documentation until requested by the Additional Documentation Request (ADR) process. If the requested medical record documentation is not made available upon request to support services billed, the service may be denied.
Medicare Guideline posts
- Finding Medicare fee schedule - HOw to Guide
- LCD and procedure to diagnosis lookup - How to Gui...
- Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,
- Step by step Guide Medicare participation program
- Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203
- Medicare revalidation FAQ
- Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee
- Medicare claim address, phone numbers, payor id - revised list
Top Medicare billing tips
Procedure code and description 93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report -average fee...
This post has Most used J code list and we are constantly updating with example . If you are looking particular J code, use search button. ...
CPT CODES and Description 81000 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitr...
Flow Cytometry is a highly complex process by which blood, body fluids, bone marrow and tissue can be examined. It provides important immun...
Procedure code and description 93015 (cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous ele...
Coverage Indications, Limitations, and/or Medical Necessity This LCD describes conditions under which the coverage of nail avulsion/ex...
Procedure Codes and Definitions 36415 Collection of venous blood by venipuncture - Fee schedule amount $3.10 36416 Collection of capi...
Molecular diagnostic testing, which includes DNA- or RNA-based analysis, with or without amplification/quantification, provides sensitive, ...
procedure code and description 93922 LIMITED BILATERAL NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, (EG, FOR LOW...
Procedure code and description 95004 Percut Tests w/ Extrac Immed React # Allergy testing - Percut allergy skin tests - Percutaneous ...