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We discovered the "zero" dollar G8553 code was not being submitted to M'care on the claims

CPS, C-EMR, PM

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Anonymous

(@Anonymous)

Posts: 0

New Member Guest

Topic starter

Has anyone else had this experience & if so, were you able to appeal it with CMS. The codes were definitely entered on the visit & we can see it on the ticket & in the batch. As always, CMS wants to be difficult. I want to make sure the providers are not penalized.

Thanks - Melissa

[email protected]

904-202-5304

Posted : August 6, 2012 11:20 pm

angelahunsberger

(@angelahunsberger)

Posts: 290

Reputable Member

In your insurance carrier setup, did you have the checkbox "Include zero dollar procedures"? That is the key for those codes to go out on the claim. Can you look at your raw EDI file in EDI submission to see if the zero dollar ones went out? I can help you parse the raw file if you need.

Posted : August 6, 2012 11:35 pm

Anonymous

(@Anonymous)

Posts: 0

New Member Guest

Topic starter

Hi Angela-

That was the issue, the "include zero dollar" wasn't checked under the Medicare insurance carrier. In looking at the Patient Procedure List report we cannot find any ticket #'s that show where the G8553 went on the "claims" tab, it's only in the "charges" tab. I'm looking at the raw data in the EDI Submission, but which "record type" will give me the charges info? That would be a huge help if you could walk me through it. Thanks so much!

Melissa

Posted : August 7, 2012 12:04 am

angelahunsberger

(@angelahunsberger)

Posts: 290

Reputable Member

You may shoot me an email and we can setup an online meeting to walk through this together. I did post a reference guide just now that shows you how to parse. I am happy to walk you thorugh this. Here is another link to the guide.

[email protected]

Posted : August 7, 2012 12:16 am

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