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Find-A-Code Focus Newsletter

Important Changes to Submission of NPP E/M Claims for NGS Medicare Effective September 15, 2018

By NAMAS
August 21, 2018
National Government Services (NGS) has announced a significant change in the submission process for E/M services performed by non-physician practitioners (NPPs). These changes apply to claims submitted by NPs and PAs on and after September 15, 2018.
If you process claims under NGS Medicare, you need to be aware of these changes. In an emailed news bulletin, NGS outlines the changes as follows: 
As of 9/15/2018, the following submission, processing and payment guidelines will apply to E/M claims submitted by JK and J6 providers and groups for services by NPs (Specialty 50) and PAs (Specialty 97): 
  1. NP and PA E/M claims will continue to be submitted as per prior guidelines, indicating the rendering/billing provider as either Specialty 50 or Specialty 97.
  2. In the 2300 or 2400 Loop NTE Segment (or Box 19 on paper claims), include the specialty of the group under which the NP or PA has provided the service (e.g., Specialty 20 or Specialty 26).
  • We encourage providers to initiate this process as soon as possible; supervising specialty information is essential to the success of this processing and having this information on history claims will enhance payment for claims processed September 15th and later.
  • We also encourage providers to refrain from including other information in the 2300 or 2400 Loop NTE segment on these specific claims unless absolutely necessary.
  • An NP or PA E/M claim submitted subsequent to the first paid NP or PA claim for a date of service will be considered for payment if specialty information in Loop 2300 or 2400 NTE Segment (or Box 19 on a paper claim) varies from that on the paid claim and if detail diagnoses on the claims vary, supporting care for a different clinical condition.
  • Multiple NP and PA claims submitted for the same date of service that do not meet the above criteria will continue to be denied and may be submitted for redetermination via the standard and previously established method.
  • Providers are reminded that claims denied relative to this issue prior to 9/15/2018 may not be re-submitted and will still need to go through the standard redetermination process.
  • Beyond implementation of this editing change, NGS will continue to monitor NPP E/M claim and appeal trends, and continue to offer education as needed. We anticipate a highly successful outcome for our NPP providers and will be pleased to address questions during our upcoming webinars, mentioned above.
  • NGS will be hosting a series of webinars regarding these changes. Click the links below to register for one of their upcoming sessions:

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