tci Part B Insider - 2010 Issue 4

NURSING FACILITY CARE: Prepare Now: One MAC Institutes Pre-Pay Edit for Code 99310

87 percent error rate leads to drastic measures. If you think CMS is only watching your E/M codes when it comes to the office or hospital, think again. One MAC recently reviewed nursing facility care claims and was stunned at the findings. NGS Medicare, a Part B payer in four states, announced on Jan. 26 that it had recently audited claims for code 99310 (Subsequent nursing facility care, per day), and found that only 13 percent of these claims were billed correctly. Based on the outcome of the audit, NGS said that it "will be implementing a prepay edit...

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